Moxifloxacin Dosage

Usual Adult Dose for Bronchitis

Acute bacterial exacerbation of chronic bronchitis: 400 mg orally or IV every 24 hours for 5 days

Usual Adult Dose for Intraabdominal Infection

Complicated: 400 mg orally or IV every 24 hours for 5 to 14 days

Usual Adult Dose for Pneumonia

Community-acquired pneumonia: 400 mg orally or IV every 24 hours for 7 to 14 days

Usual Adult Dose for Sinusitis

Acute bacterial sinusitis: 400 mg orally or IV every 24 hours for 10 days

Usual Adult Dose for Skin or Soft Tissue Infection

400 mg orally or IV every 24 hours
Duration: 7 to 21 days for complicated infections; 7 days for uncomplicated infections

Usual Adult Dose for Skin and Structure Infection

400 mg orally or IV every 24 hours
Duration: 7 to 21 days for complicated infections; 7 days for uncomplicated infections

Usual Adult Dose for Inhalation Bacillus anthracis

Mass casualty treatment or prophylaxis of inhalational anthrax: 400 mg orally once a day for 60 days

The Working Group on Civilian Biodefense has suggested that, based on in vitro studies, moxifloxacin could be used for postexposure prophylaxis or treatment of inhalational anthrax if ciprofloxacin and doxycycline are not available. This use is not approved by the FDA.

Usual Adult Dose for Anthrax Prophylaxis

Mass casualty treatment or prophylaxis of inhalational anthrax: 400 mg orally once a day for 60 days

The Working Group on Civilian Biodefense has suggested that, based on in vitro studies, moxifloxacin could be used for postexposure prophylaxis or treatment of inhalational anthrax if ciprofloxacin and doxycycline are not available. This use is not approved by the FDA.

Usual Adult Dose for Tuberculosis - Active

400 mg orally or IV once a day

This regimen has been recommended by the Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Thoracic Society.

May be given in combination with at least 3 other active drugs for treatment of multi-drug resistant TB, or when the patient is intolerant of first-line agents. AFB smear and culture should be monitored monthly.

Duration: Treatment for TB should generally continue for 18 to 24 months, or for 12 to 18 months after culture results are negative.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

No adjustment recommended. However, the manufacturer recommends caution when administering this drug to patients with liver dysfunction.

Precautions

Fluoroquinolones, including moxifloxacin, have been associated with an increased risk of tendonitis and tendon rupture in all ages. The risk is further increased in older patients usually over 60 years of age, in kidney, heart, or lung transplant recipients, and with the use of concomitant corticosteroids. Independent risk factors include strenuous physical activity, renal failure, and previous tendon disorders such as rheumatoid arthritis; however, cases have been reported in patients with no known risk factors. Tendon rupture may occur during or up to several months after completion of therapy. Patients should be advised to discontinue moxifloxacin, rest and avoid exercise, and contact their healthcare provider if they experience tendon pain, swelling, inflammation, or rupture.

Fluoroquinolones, including moxifloxacin, have neuromuscular blocking activity and may exacerbate muscle weakness in patients with myasthenia gravis. Postmarketing serious adverse events, including death and need for ventilatory support, have been reported with fluoroquinolones in myasthenia gravis patients. Patients should contact their healthcare provider at once if worsening muscle weakness or breathing problems develop. Moxifloxacin should be avoided in patients with a known history of myasthenia gravis.

Moxifloxacin has been shown to prolong the QT interval of the electrocardiogram in some patients. Due to lack of clinical experience, moxifloxacin should be avoided in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia, and patients receiving Class IA or Class III antiarrhythmic agents. Caution is recommended during coadministration of moxifloxacin with other drugs that prolong the QT interval. Moxifloxacin should be used with caution in patients with ongoing proarrhythmic conditions. The recommended dose or infusion rate should not be exceeded since the magnitude of QT prolongation may increase with increased concentrations of the drug or increased rates of IV infusion. Patients should be advised to contact their physician if they experience syncope, irregular heartbeats, or palpitations during moxifloxacin therapy.

Moxifloxacin should be used with caution in patients with hepatic insufficiency (including mild, moderate, or severe liver cirrhosis) due to associated metabolic disturbances which may lead to QT interval prolongation.

Fluoroquinolones, including moxifloxacin, may cause central nervous system (CNS) events, including nervousness, agitation, insomnia, anxiety, nightmares, or paranoia. Convulsions, increased intracranial pressure (including pseudotumor cerebri), and toxic psychosis have been reported with fluoroquinolones. Fluoroquinolones may also cause CNS events, including dizziness, tremors, restlessness, anxiety, lightheadedness, confusion, hallucinations, depression, and rarely, suicidal thoughts or acts. These reactions may occur following the first dose. Moxifloxacin should be discontinued and appropriate measures taken if these reactions occur. Moxifloxacin should be used with caution in patients with a known or suspected CNS disorder or other risk factors that may predispose them to seizures or lower the seizure threshold. Patients should be advised to avoid driving or engaging in other tasks that require alertness and coordination until they know how the drug affects them.

Serious and occasionally fatal hypersensitivity and/or anaphylactic reactions have been reported; some following the first dose. The drug should be discontinued immediately at the first appearance of a skin rash, jaundice, or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support, and airway management as clinically indicated.

Patients should be advised to avoid excessive exposure to sunlight or artificial ultraviolet light during and for several days after treatment. The drug should be discontinued if photosensitivity or signs of phototoxicity (e.g., sunburn-like reaction, redness, oozing, burning, itching, rash, blistering, edema) occur.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following quinolone therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Patients should be well hydrated to prevent concentrated urine.

To reduce the risk of development of drug resistant organisms, antibiotics should only be used to treat or prevent proven or suspected infections caused by bacteria. Culture and susceptibility information should be considered when selecting treatment or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy. Patients should be advised to avoid missing doses and to complete the entire course of therapy.

Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

Hemodialysis and peritoneal dialysis: No adjustment recommended.

Other Comments

The manufacturer's Medication Guide should be dispensed with each new and refill prescription.

Moxifloxacin may be taken without regard to meals. Patients should be advised to drink plenty of fluids. Oral doses should be administered at least 4 hours before or 8 hours after iron-, zinc-, aluminum-, or magnesium-containing compounds (e.g., antacids, sucralfate, mineral supplements, buffered didanosine).

IV doses should be administered over at least 60 minutes.

Moxifloxacin injection is only for intravenous use and should not be refrigerated because it will precipitate. The injection contains about 787 mg of sodium in 250 mL.

Sequential therapy (IV to oral) may be started at the physician's discretion.

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