Infectious Disease Compendium

Moxifloxacin (Avelox®)

Dosing

CrCl Formula

CrCl > 80: 400 mg po/iv q d.

CrCl 80-50: 400 mg po/iv q d.

CrCl 50-10: 400 mg po/iv q d.

CrCl < 10: 400 mg po/iv q d.

Hemodialysis: no mention in PDR.

Peritoneal dialysis: no mention in PDR.

Obesity dosing

Important side effects

Diarrhea, nausea, dizziness, headache, peripheral neuropathy, qt interval prolongation (rare), severe hypersensitivity reactions (rare), tendon rupture (rare). Diplopia (PubMed).

Maybe retinal detachment (PubMed). Or not (PubMed). Probably for rhegmatogenous retinal detachment (PubMed).

Liver disease in the elderly (about 6 in 100,000) (PubMed).

Can double the risk of acute kidney injury (PubMed).

Arrhythmias: "Gatifloxacin use was associated with the highest rate (RR = 7.38; 95% CI, 2.30-23.70); moxifloxacin and ciprofloxacin were also associated with elevated rates of serious arrhythmia (RR = 3.30; 95% CI, 1.47-7.37 and RR = 2.15; 95% CI, 1.34-3.46, respectively)" (PubMed). Not so much with levofloxicin.

Important drug interactions

Antacids, antidiabetic agents, cisapride, class ia antiarrhythmic agents, class iii antiarrhythmic agents, corticosteroids, didanosine, erythromycin, erythromycin/sulfisoxazole, iron, mesoridazine, phenothiazines, sucralfate, thioridazine, tricyclic antidepressants, zinc, ziprasidone.

Rants and Screeds

Finally, a quinolone that is decent against streptococci and staphylococci.

Pearls

As with all quinolones, antacids bind the drug to prevent absorbtion.

Treatment of choice

Use for

Along with there respiratory quinolone of choice. Bronchitis, Cellulitis, community-acquired Pneumonia, Conjunctivitis, Sinusitis, Tuberculosis.

Don't use for

UTI, it is not excreted in the urine.

Class

Quinolone.