II. Indications

  1. Conditions
    1. Community Acquired Pneumonia (including Penicillin-resistant pneumococcus)
    2. Refractory acute Bacterial Sinusitis (third line agent)
    3. Skin and Soft Tissue Infections
    4. Avoid in UTI (Bladder concentrations too low)
  2. Activity Spectrum
    1. Moderate to good Gram Positive activity (includes Streptococcus Pneumoniae)
    2. Aerobic Gram Negative Rod coverage (see other Fluoroquinolones)
      1. Less activity than other Fluoroquinolones
      2. Enterobacteriaceae
      3. Does not cover Pseudomonas
    3. Atypical Bacteria
    4. Anaerobic Coverage
      1. Only Fluoroquinolone to have anaerobic coverage

III. Contraindications

  1. See Fluoroquinolone
  2. Myasthenia Gravis (exacerbates motor weakness)
  3. Ziprasidone use

IV. Mechanism

  1. See Fluoroquinolone
  2. Low urine concentrations (avoid in UTI)
  3. No Pseudomonas coverage

V. Dosing

  1. Take 400 mg orally or IV daily

VI. Pharmacokinetics

  1. Excellent oral Bioavailability (similar to Levofloxacin)
    1. Oral and Intravenous dosing are the same

VII. Adverse Effects

  1. See Fluoroquinolone
  2. Fluoroquinolones have several serious warnings (e.g. tendon rupture, Neuropathy, Aortic Dissection)
  3. QT Prolongation
    1. Moxifloxacin is the highest risk Quinolone for QT Prolongation
    2. Avoid in known Prolonged QT, Hypokalemia or in combination of Class 1 or Class 3 Antiarrhythmics

VIII. Safety

  1. Pregnancy Category X in first trimester (unknown safety in other trimesters)
  2. Unknown safety in Lactation
    1. Risk of pediatric Arthropathy

IX. Drug Interactions

  1. Sulfonylureas and other antidiabetic medications
    1. Hypoglycemia risk
  2. Ziprasidone
    1. Do not use with Moxifloxacin
  3. Drug-Induced QTc Prolongation
    1. Avoid combining with agents that prolong QT Interval
  4. Drugs that interfere with absorption (give dose at least 4 hours before or 8 hours after)
    1. Antacids containing Calcium, aluminum or Magnesium
    2. Sucralfate
    3. Iron
    4. Zinc
    5. Yogurt, milk or Calcium fortified juice (but may take with dairy containing meals)

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Cost: Medications

moxifloxacin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
MOXIFLOXACIN 0.5% EYE DROPS Generic $3.48 per ml
MOXIFLOXACIN HCL 400 MG TABLET Generic $1.38 each