Moxifloxacin

Generality

Moxifloxacin is a synthetic antibacterial belonging to the class of quinolones. More precisely, moxifloxacin is a fluoroquinolone.

Moxifloxacin - Chemical Structure

It is marketed in the form of pharmaceutical formulations suitable for oral, parenteral and ocular administration.

Indications

For what it uses

The use of moxifloxacin is indicated for the treatment of:

Lung infections (oral and parenteral administration);
Paranasal sinus infections (oral administration);
Mild to moderate infections of the upper part of the female genital tract, including infections of the fallopian tubes and uterine mucosa (moxifloxacin administered orally in association with other antibiotics);
Skin and soft tissue infections (parenteral administration);
Eye infections (ocular administration).

Warnings

Before taking moxifloxacin orally or parenterally, inform your doctor if you are in any of the following conditions:

If you suffer from epilepsy or other seizure disorders;
If you suffer from myasthenia gravis;
If there are deficiencies of the enzyme glucose-6-phosphate dehydrogenase.

Moxifloxacin can cause heart problems. The risk of such problems arising increases with the dose of moxifloxacin taken.

In the event of any type of allergic reaction, treatment with moxifloxacin should be stopped immediately and the doctor should be contacted immediately.

Should convulsions occur during treatment with moxifloxacin, therapy with the drug should be stopped immediately.

Moxifloxacin may induce photosensitivity reactions, therefore, prolonged exposure to sunlight or exposure to UV rays is not recommended.

Caution should be exercised when administering moxifloxacin in patients already on oral anticoagulants therapy.

If an ocular infection occurs during ocular treatment with moxifloxacin, patients who wear contact lenses should discontinue use and use eyeglasses in their place. Contact lens wear should not be resumed until treatment with moxifloxacin is complete.

Moxifloxacin can cause side effects that can alter the ability to drive and / or use machinery, so caution should be used.

Interactions

Concomitant intake of moxifloxacin and other drugs capable of altering the heart rhythm leads to an increased risk of developing side effects affecting the heart. Among these drugs, we recall:

Antiarrhythmic drugs;
Antipsychotic drugs;
Tricyclic antidepressants ;
Erythromycin, a macrolide;
Saquinavir, an antiviral used in AIDS therapy;
Antimalarial drugs, such as halofantrine;
Some antihistamine drugs, such as terfenadine, astemizole and mizolastine.

Also, you need to tell your doctor if you are taking drugs that can lower your blood potassium levels.

Antacid drugs containing magnesium or aluminum and products containing iron, zinc or sucralfate can reduce the intestinal absorption of moxifloxacin, therefore, such associations should be avoided.

In any case - regardless of the route of administration chosen - it is however advisable to inform your doctor if you are taking, or have recently been taken, medicines of any kind, including non-prescription drugs and herbal and / or homeopathic products .

Side effects

Moxifloxacin can cause various types of side effects, although not all patients experience them. The type of adverse effects and the intensity with which they occur depend on each person's sensitivity to the drug.

The main side effects that may occur during moxifloxacin therapy are listed below.

Blood and lymphatic system disorders

Treatment with moxifloxacin may cause:

Leukopenia, ie the decrease in the number of leukocytes in the bloodstream;
Neutropenia, ie decrease in the number of neutrophils in the bloodstream;
Agranulocytosis, ie the decrease in the number of granulocytes in the bloodstream;
Increased or decreased number of platelets in the blood;
Increase in prothrombin time;
Eosinophilia, that is the increase in the number of eosinophils in the bloodstream;
Reduced number of red blood cells.

Pathologies of the central nervous system

Treatment with moxifloxacin may cause:

Headache;
dizziness;
Peripheral neuropathy;
Changes in the sense of taste, touch and smell;
Confusion;
Disorientation;
Drowsiness;
Changes in equilibrium;
Decreased coordination;
Speech disorders;
Difficulty concentrating;
Convulsions.

Psychiatric disorders

Moxifloxacin therapy may cause:

Anxiety;
Agitation and restlessness;
Depression;
Hallucinations;
Emotional instability.

Cardiovascular disorders

Treatment with moxifloxacin may promote the onset of:

vasodilation;
Hypotension or hypertension;
Palpitations;
Cardiac rhythm disorders;
Angina pectoris;
Mancamento.

Gastrointestinal disorders

Moxifloxacin therapy may cause:

Nausea or vomiting;
Diarrhea;
Abdominal pains;
Meteorism and constipation;
Inflammation of the stomach;
Antibiotic colitis.

Hepatobiliary disorders

Treatment with moxifloxacin may cause increased transaminase blood levels, changes in liver function, increased bilirubinemia, jaundice, hepatitis and liver failure, sometimes with fatal results.

Skin and subcutaneous tissue disorders

Moxifloxacin therapy may cause:

Itch;
Skin eruptions;
Urticaria;
Dryness of the skin;
Appearance of vesicles on skin and mucous membranes;
Stevens-Johnson syndrome;
Toxic epidermal necrolysis.

Musculoskeletal disorders

Treatment with moxifloxacin can cause arthralgia, myalgia, tendinitis, muscle cramps and spasms, arthritis and muscle stiffness. Furthermore, the drug may worsen the symptoms of myasthenia gravis in patients who are affected.

Other side effects

Other side effects that may occur during moxifloxacin therapy are:

Allergic reactions in sensitive individuals;
Fatigue and weakness;
pains;
Swelling;
Hyperglycemia, hyperuricemia and increased lipid levels in the blood;
Tinnitus;
Decrease or loss of hearing;
Difficulty breathing;
Diplopia or blurred vision;
Temporary loss of sight;
Dehydration;
Impaired renal function.

Side effects typical of ocular administration

In addition to some of the adverse effects described above, moxifloxacin administered via the eye can promote the onset of:

Itching, swelling, redness, dryness, pain or eye irritation;
Inflammation or scarring of the ocular surface;
Rupture of ocular blood vessels;
Eye fatigue;
Inflammation or infection of the conjunctiva.

Overdose

If you take an overdose of oral moxifloxacin, you must contact your doctor immediately or go to the nearest hospital.

If an overdosage with moxifloxacin is suspected intravenously, the doctor or nurse should be informed immediately.

If an excessive amount of moxifloxacin is used via the eye, it is necessary to immediately rinse the eye with water.

Action mechanism

Moxifloxacin, as quinolone, exerts its bactericidal action (ie it is able to kill bacterial cells) by inhibiting DNA gyrase and topoisomerase IV.

DNA gyrase and topoisomerase IV are bacterial enzymes involved in the supercoiling, rewinding, cutting and welding processes of the two strands that make up DNA.

With the inhibition of these two enzymes, the bacterial cell can no longer access the information contained within its genes. In this way, all cellular processes (including replication) are blocked and the beating dies.

Mode of Use - Posology

Moxifloxacin is available for:

Oral administration in the form of tablets;
Intravenous administration as a solution for infusion;
Administration by eye in the form of eye drops.

During the treatment based on moxifloxacin, it is essential to strictly adhere to the indications provided by the doctor, both as regards the amount of drug to be taken and the duration of the treatment.

Below are some indications on the doses of moxifloxacin usually used in therapy.

Oral administration

In adults, the recommended dose of moxifloxacin is 400 mg a day, to be taken in a single dose. The duration of treatment varies depending on the type of infection that must be treated.

The tablets should be swallowed whole with the help of plenty of water or another drink.

The use of oral moxifloxacin in children and adolescents under 18 years of age is not recommended.

Intravenous administration

Intravenous moxifloxacin should always be administered by a doctor or nurse.

The recommended dose is 400 mg of drug administered via an intravenous infusion, at a constant rate, lasting 60 minutes.

Your doctor will determine the duration of treatment with moxifloxacin by infusion and decide whether or not you should continue with moxifloxacin orally.

The use of intravenous moxifloxacin in children and adolescents under 18 years of age is not recommended.

Ocular administration

Ocular moxifloxacin can be used both in adults and in children and the elderly.

It is advised to instill a drop of eye drops in the affected eye three times a day. The duration of treatment must be established by the doctor.

Pregnancy and breastfeeding

The use of oral and parenteral moxifloxacin by pregnant women and by breast-feeding mothers is not recommended.

For moxifloxacin administered via the eye, pregnant women or breast-feeding women should seek medical advice before taking it.

In any case, before taking any type of medication, pregnant women and breastfeeding mothers should definitely seek medical advice.

Contraindications

The use of moxifloxacin is contraindicated in the following cases:

In patients with known hypersensitivity to moxifloxacin itself;
In patients with known hypersensitivity to other quinolones;
In patients who have suffered from tendon problems following the use of other quinolones (only when moxifloxacin is administered orally or parenterally);
In patients suffering from cardiac rhythm disorders (only when moxifloxacin is administered orally or parenterally);
In patients suffering from severe liver disease (only when moxifloxacin is administered orally or parenterally);
In patients under 18 years of age (only when moxifloxacin is administered orally or parenterally);
In pregnancy and during lactation (only when moxifloxacin is administered orally or parenterally).