Brand and Other Names:Avelox, Moxifloxacin Systemic
- Classes: Fluoroquinolones
Dosing & Uses
Dosage Forms & Strengths
Acute Bacterial Sinusitis
400 mg PO/IV qDay for 5-10 days
400 mg PO/IV qDay for 7-14 days
Acute Exacerbation of Chronic Bronchitis
Indicated for acute exacerbations of chronic bronchitis caused by bacterial infections
400 mg PO/IV qDay for 5 days
Skin & Skin Structure Infections
Uncomplicated: 400 mg PO/IV qDay for 7 days
Complicated: 400 mg PO/IV qDay for 7-21 days
Complicated: 400 mg PO/IV qDay for 5-14 days
Pneumonic & Septicemic Plague
Indicated in adults for the treatment of plague, including pneumonic and septicemic plague, caused by susceptible isolates of Yersinia pestis; it is also indicated for prophylaxis of plague in adults
400 mg PO/IV qDay x10-14 days
Begin administration as soon as possible after suspected or confirmed exposure to Yersinia pestis
Initial IV administration may be changed to PO administration at same dosage to complete therapy, depending on patient's clinical status
- Aeromonas hydrophila, Bacillus anthracis, Bacteroides fragilis, Bacteroides thetaiotaomicron, Campylobacter jejuni, Citrobacter diversus, Citrobacter freundii, Clostridium perfringens, Escherichia coli, Enterobacter spp, Haemophilus influenzae, Hafnia alvei, Klebsiella pneumoniae, Legionella pneumophila, Morganella morganii, Moraxella catarrhalis, Mycobacterium pneumoniae, Mycobacterium tuberculosis, Neisseria gonorrhoeae, Peptostreptococcus spp, Proteus mirabilis, Proteus vulgaris, Providencia spp, Pseudomonas aeruginosa, Salmonella typhi, Shigella spp, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus anginosus, Streptococcus constellatus, Streptococcus pneumoniae, Vibrio cholerae, Yersinia pestis
- First-line therapy: C jejuni; no unanimity on others (eg, L pneumophila, M morganii)
<18 years: Safety and efficacy not established
Serious - Use Alternative
Significant - Monitor Closely
Decreased amylase (2%)
Decreased basophils, eosinophils, hemoglobin, prothrombin time, red blood cells, neutrophils (2%)
Decreased serum glucose (2%)
Increased serum chloride (2%)
Increased serum ionized calcium (2%)
Immune hypersensitivity reaction (0.1-2%)
Prolonged QT interval (0.1-2%)
Acute renal failure
Extrinsic allergic alveolitis
Serum sickness due to drug
Tendon rupture, tendinitis
Torsades de pointes
Toxic epidermal necrolysis
Blood and lymphatic disorders: Agranulocytosis, pancytopenia
Cardiovascular disorders: Ventricular tachyarrhythmias (including in very rare cases cardiac arrest and torsade de pointes)
Ear and labyrinth disorders: Hearing impairment, including deafness (reversible in most cases)
Eye disorders: Vision loss (especially in the course of CNS reactions, transient in majority of cases)
Hepatobiliary disorders: Hepatitis, hepatic failure, jaundice, acute hepatic necrosis
Immune system disorders: Anaphylactic reactions including shock, angioedema (including laryngeal edema)
Musculoskeletal/connective tissue disorders: Tendon rupture
Nervous system disorders: Exacerbation of myasthenia gravis symptoms, altered coordination, abnormal gait, muscle weakness, peripheral neuropathy, polyneuropathy
Psychiatric disorders: Psychotic reaction (very rarely culminating in self-injurious behavior, such as suicidal ideation/thoughts or suicide attempts)
Renal and urinary disorders: Renal dysfunction, interstitial nephritis
Respiratory disorders: Allergic pneumonitis
Skin and tissue disorders: Photosensitivity/phototoxicity reaction, Stevens-Johnson syndrome, Toxic epidermal necrolysis
Black Box Warnings
Fluoroquinolones are associated with increased risk of tendinitis and tendon rupture; this risk is further increased in older patients (usually >60 years); in kidney, heart, and lung transplant recipients; and with use of concomitant steroid therapy
May exacerbate muscle weakness in patients with myasthenia gravis; fluoroquinolones should be avoided in patients with known history of myasthenia gravis
Hyersensitivity to drug or component
In prolonged therapy, perform periodic evaluations of organ system function (eg, renal, hepatic, hematopoietic); superinfections may occur with prolonged or repeated antibiotic therapy
Phototoxicity reactions may occur; avoid excessive sunlight
Use caution in cardiovascular disease especially significant bradycardia or acute myocardial ischemia
Peripheral neuropathy: Sensory or sensorimotor axonal polyneuropathy affecting small and/or large axons resulting in paresthesias, hypoesthesias, dysesthesias, and weakness reported; peripheral neuropathy may occur rapidly after initiating and may potentially become permanent
Serious, sometimes fatal hypogycemia reported including in patients without a history of hypoglycemia (common with gatifloxacin, which is no longer marketed); monitor glucose levels closely in patients with diabetes; if hypoglycemic reaction occurs, discontinue therapy and initiate appropriate therapy immediately
Fulminant hepatitis, potentially leading to liver failure reported; discontinue treatment if hepatitis symptoms occur
Risk of tendinitis or tendon rupture
Avoid use in presence of drugs or conditions that prolong QT interval, uncorrected hypomagnesemia or hypokalemia
Hallucinations, convulsions, and increased intracranial pressure (including pseudotumor cerebri) and toxic psychosis reported
Acute onset of retinal detachment increased 4.5-fold with oral fluoroquinolones in a single case-controlled study - JAMA 2012;307(13):1414-1419; another study disputes these findings (relative risk, 1.29) - JAMA 2013;310(20):2184-2190
Use caution in patients with a history of diabetes, hepatic impairment, renal impairment, or rheumatoid arthrtitis
As with all fluoroquinolones, disturbances in blood glucose, including both hypoglycemia and hyperglycemia have been reported in diabetic patients; monitor blood glucose
Pregnancy & Lactation
Pregnancy category: C
Lactation: Unknown if excreted in milk; discontinue drug, or do not nurse
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Inhibits A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription
Well absorbed; absorption is not affected by high-fat meal or yogurt
Protein bound: 50%
Vd: 1.7-2.7 L/kg; tissue concentrations often exceed plasma concentrations in respiratory tissues, alveolar macrophages, and sinus tissues
Metabolized in liver via glucuronide (14%) and sulfate (38%) conjugation
Half-life: PO, 12 hr; IV, 15 hr
Excretion: Feces (25%), urine (20% as unchanged drug)
Sulfate conjugate metabolites are excreted in feces, glucuronide conjugate metabolites in urine
No further dilution of infusion solution is necessary
Infuse over 1 hour
Do not admix with other drugs or infuse through same tubing simultaneously
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