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moxifloxacin
generic
Black Box Warnings .
Disabling, Potentially Irreversible Serious Reactions
fluoroquinolones associated with tendinitis/tendon rupture, peripheral neuropathy, and CNS effects that may occur together; tendinitis/tendon rupture may occur during tx or months after tx D/C; incr. tendinitis/tendon rupture risk in all ages; risk further incr. in older patients >60 yo, patients taking corticosteroids, and patients with kidney, heart, or lung transplant; D/C immediately and avoid fluoroquinolone use in patients with these serious reactions
Avoid in Myasthenia Gravis
fluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis
Reserve Fluoroquinolone Use
for patients with no alternative tx options for acute bacterial sinusitis or acute bacterial exacerbation of chronic bronchitis
Adult Dosing .
Dosage forms: TAB: 400 mg; INJ: various
intra-abdominal infections, complicated
- [400 mg PO/IV q24h x5-14 days]
pneumonia, community-acquired
- [400 mg PO/IV q24h for at least 5 days]
- Info: may be part of multi-drug regimen; refer to IDSA guidelines
skin/skin structure infections, bacterial
- [400 mg PO/IV q24h x7-21 days]
plague
- [400 mg PO/IV q24h x 10-14 days]
- Info: for prophylaxis and tx
chronic bronchitis, acute bacterial exacerbation
- [400 mg PO/IV q24h x5 days]
- Info: for patients with no alternative tx options
sinusitis, acute bacterial
- [400 mg PO/IV q24h x5-10 days]
- Info: for patients with no alternative tx options
PID (off-label)
- [400 mg PO/IV q24h x14 days]
- Info: for patients with cephalosporin allergy and low gonorrhea risk; give with metronidazole
tuberculosis, active (off-label)
- [400 mg PO q24h]
- Info: not 1st-line agent; part of multi-drug regimen
anthrax (off-label)
- [systemic]
- Dose: 400 mg IV q24h for at least 2wk; Info: not 1st-line agent; part of multi-drug regimen; may use in pregnant patients; switch to PO antibiotic for post-exposure prophylaxis if inhalational exposure
- [cutaneous]
- Dose: 400 mg PO q24h x7-10 days; Info: for non-systemic infection; may use in pregnant patients; use extended duration for post-exposure prophylaxis if bioterrorism suspected
- [post-exposure prophylaxis]
- Dose: 400 mg PO q24h x60 days; Info: not 1st-line agent; give in combo with anthrax vaccine; may use in pregnant patients; may give x42 days or x14 days after last vaccine dose in immunocompetent patients 18-65 yo if anthrax vaccine regimen completed
leprosy (Hansen disease), multibacillary (off-label)
- [patients who cannot take clofazimine]
- Dose: 400 mg PO qd x12mo; Info: not 1st-line agent; part of multi-drug regimen; may continue tx beyond 12mo in refractory cases
- [patients who cannot take rifampin]
- Dose: 400 mg PO qd x24mo; Info: not 1st-line agent; part of multi-drug regimen; may continue tx beyond 24mo in refractory cases
leprosy (Hansen disease), paucibacillary (off-label)
- [patients who cannot take rifampin]
- Dose: 400 mg PO qd x24mo; Info: not 1st-line agent; part of multi-drug regimen; may continue tx beyond 24mo in refractory cases
endocarditis (off-label)
- [400 mg IV q24h]
- Info: not 1st-line tx; dose, frequency, duration vary with pathogen susceptibility, infection severity, valve type; refer to AHA guidelines
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: TAB: 400 mg; INJ: various
community-acquired pneumonia, atypical (off-label)
- [adolescents with skeletal maturity]
- Dose: 400 mg PO q24h x7-10 days
PID (off-label)
- [adolescents]
- Dose: 400 mg PO/IV q24h x14 days; Info: for patients with cephalosporin allergy and low gonorrhea risk; give with metronidazole
tuberculosis, active (off-label)
- [10 mg/kg/dose PO q24h]
- Info: not 1st-line agent; part of multi-drug regimen
anthrax, systemic (off-label)
- [neonates >32 wk gestation]
- Dose: 5-10 mg/kg/dose IV q24h for at least 2wk; Info: for CNS anthrax; not 1st-line agent; part of multi-drug regimen; dose depends on gestational and post-natal age; switch to PO antibiotic x60 days total if inhalational exposure
- [3-23 mo]
- Dose: 12 mg/kg/day IV divided q12h for at least 2wk; Max: 200 mg/dose; Info: for CNS anthrax; not 1st-line agent; part of multi-drug regimen; switch to PO antibiotic x60 days total if inhalational exposure
- [2-5 yo]
- Dose: 10 mg/kg/day IV divided q12h for at least 2wk; Max: 200 mg/dose; Info: for CNS anthrax; not 1st-line agent; part of multi-drug regimen; switch to PO antibiotic x60 days total if inhalational exposure
- [6-11 yo]
- Dose: 8 mg/kg/day IV divided q12h for at least 2wk; Max: 200 mg/dose; Info: for CNS anthrax; not 1st-line agent; part of multi-drug regimen; switch to PO antibiotic x60 days total if inhalational exposure
- [12-17 yo, <45 kg]
- Dose: 8 mg/kg/day IV divided q12h for at least 2wk; Max: 200 mg/dose; Info: for CNS anthrax; not 1st-line agent; part of multi-drug regimen; switch to PO antibiotic x60 days total if inhalational exposure
- [12-17 yo, >45 kg]
- Dose: 400 mg IV q24h for at least 2wk; Info: for CNS anthrax; not 1st-line agent; part of multi-drug regimen; switch to PO antibiotic x60 days total if inhalational exposure
leprosy (Hansen disease), multibacillary (off-label)
- [15 yo and older, patients who cannot take clofazimine]
- Dose: 400 mg PO qd x12mo; Info: not 1st-line agent; part of multi-drug regimen; may continue tx beyond 12mo in refractory cases
- [15 yo and older, patients who cannot take rifampin]
- Dose: 400 mg PO qd x24mo; Info: not 1st-line agent; part of multi-drug regimen; may continue tx beyond 24mo in refractory cases
leprosy (Hansen disease), paucibacillary (off-label)
- [15 yo and older, patients who cannot take rifampin]
- Dose: 400 mg PO qd x24mo; Info: not 1st-line agent; part of multi-drug regimen; may continue tx beyond 24mo in refractory cases
renal dosing
- [no adjustment]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: consider adult renal dosing for guidance
hepatic dosing
- [no adjustment]