Moxifloxacin is an antibiotic, used to treat bacterial infections, including pneumonia, conjunctivitis, endocarditis, tuberculosis, and sinusitis. It can be given by mouth, by injection into a vein, and as an eye drop.
Common side effects include diarrhea, dizziness, and headache. Severe side effects may include spontaneous tendon ruptures, nerve damage, and worsening of myasthenia gravis. Safety of use in pregnancy and breastfeeding is unclear. Moxifloxacin is in the fluoroquinolone family of medications. It usually kills bacteria by blocking their ability to duplicate DNA.
Moxifloxacin was patented in 1988 and approved for use in the United States in 1999. It is on the World Health Organization's List of Essential Medicines.
Medical uses
Moxifloxacin treats a number of infections, including respiratory-tract infections, cellulitis, anthrax, intra-abdominal infections, endocarditis, meningitis, and tuberculosis.
In the United States, moxifloxacin is licensed for the treatment of acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, community-acquired pneumonia, complicated and uncomplicated infections of the skin and of the skin structure, and complicated intra-abdominal infections. In the European Union, it is licensed for acute bacterial exacerbations of chronic bronchitis, non-severe community-acquired pneumonia, and acute bacterial sinusitis. On the basis of its investigation into reports of rare but severe cases of liver toxicity and skin reactions, the European Medicines Agency recommended in 2008 that the use of the oral (but not the intravenous) form of moxifloxacin be restricted to infections in which other antibacterial agents cannot be used or have failed. In the United States, the marketing approval does not contain these restrictions, though the label contains prominent warnings of skin reactions.
The initial approval by the Food and Drug Administration of the United States (December 1999) encompassed these indications: Acute exacerbations of chronic bronchitis Acute bacterial sinusitis Community acquired pneumonia
Additional indications approved by the Food and Drug Administration: April 2001: Uncomplicated skin and skin-structure infections May 2004: Community-acquired pneumonia caused by multidrug-resistant Streptococcus pneumoniae June 2005: Complicated skin and skin-structure infections November 2005: Complicated intra-abdominal infections
The European Medicines Agency has advised that, for pneumonia, acute bacterial sinusitis, and acute exacerbations of COPD, it should only be used when other antibiotics are inappropriate.
Oral and intravenous moxifloxacin have not been approved for children. Several drugs in this class, including moxifloxacin, are not licensed by the Food and Drug Administration for use in children, because of the risk of permanent injury to the musculoskeletal system. Moxifloxacin eye drops are approved for conjunctival infections caused by susceptible bacteria.
Recently, alarming reports of moxifloxacin resistance rates among anaerobes have been published. In Austria 36% of Bacteroides have been reported to be resistant to moxifloxacin, while in Italy resistance rates as high as 41% have been reported.
Susceptible bacteria
A broad spectrum of bacteria is susceptible, including the following: Staphylococcus aureus Staphylococcus epidermidis Streptococcus pneumoniae Haemophilus influenzae Klebsiella spp. Moraxella catarrhalis Enterobacter spp. Mycobacterium spp. Bacillus anthracis Mycoplasma genitalium
Adverse effects
Rare but serious adverse effects that may occur as a result of moxifloxacin therapy include irreversible peripheral neuropathy, spontaneous tendon rupture and tendonitis, hepatitis, psychiatric effects (hallucinations, depression), torsades de pointes, Stevens–Johnson syndrome and Clostridium difficile-associated disease, and photosensitivity/phototoxicity reactions.
Several reports suggest the use of moxifloxacin may lead to uveitis.
Pregnancy and breastfeeding
Exposure of the developing fetus to quinolones, including levofloxacin, during the first-trimester is not associated with an increased risk of stillbirths, premature births, birth defects, or low birth weight. There is limited data about the appearance of moxifloxacin in human breastmilk. Animal studies have found that moxifloxacin appears in significant concentration in breastmilk. Decisions as to whether to continue therapy during pregnancy or while breast feeding should take the potential risk of harm to the fetus or child into account, as well as the importance of the drug to the well-being of the mother.