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| | __NOTOC__ |
| | {{Moxifloxacin}} |
| | {{CMG}};{{AE}}{{AK}} |
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| '''Moxifloxacin''' is a synthetic [[quinolone|fluoroquinolone]] [[antibiotic]] agent. [[Bayer AG]] developed the drug (initially called '''BAY 12-8039''') and it is marketed worldwide (as the hydrochloride) under the brand name '''Avelox®''' (in some countries also '''Avalox®''') for oral treatment. Each tablet contains 400 mg. In most countries the drug is also available in parenteral form for [[Intravenous therapy|intravenous]] infusion. Moxifloxacin is also sold in an ophthalmic solution (eye drops) under the name '''Vigamox®''' for the treatment of [[conjunctivitis]].
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| ==Mode of action==
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| Moxifloxacin inhibits bacterial topoisomerase II (DNA gyrase) and topoisomerase IV. Topoisomerases are essential enzymes which play a crucial role in the replication and repair of bacterial DNA. This mechanism is lethal to susceptible bacteria. Moxifloxacin is often referred to as a chemotherapeutic drug because its mode of action has so far not been noted in any natural occurring or semi-synthetic antibiotic.
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| ==Distribution== | | ==Overview== |
| Moxifloxacin is found in high concentrations in body tissues and fluids, such as saliva, nasal and bronchial secretions, sinus mucosa, skin blister fluid, subcutaneous and intraocular tissues. There is good penetration into bone.<ref>{{cite journal | journal=J Antimicrob Chemother | author=Malincarne L, Ghebregzabher M, Moretti M, ''et al.'' | title=Penetration of moxifloxacin into bone in patients undergoing total knee arthroplasty | year=2006 | volume=57 | issue=5 | pages=950–4 | doi=10.1093/jac/dkl091}}</ref> Pus does not seem to inhibit the drug's potential to reach effective concentrations in infectious foci easily.
| | '''Moxifloxacin''' is a synthetic [[quinolone|fluoroquinolone]] [[antibiotic]] agent. [[Bayer AG]] developed the drug (initially called '''BAY 12-8039''') and it is marketed worldwide (as the hydrochloride) under the brand name '''Avelox®''' (in some countries also '''Avalox®''') for oral treatment. Each tablet contains 400 mg. In most countries the drug is also available in parenteral form for [[Intravenous therapy|intravenous]] infusion. Moxifloxacin is also sold in an ophthalmic solution (eye drops) under the name '''Vigamox®''' for the treatment of [[conjunctivitis]]. |
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| ==Susceptible bacteria==
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| A broad spectrum of bacteria is susceptible including, but not limited to:
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| *''[[Staphylococcus aureus]]''
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| *''[[Staphylococcus epidermidis]]''
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| *''[[Streptococcus pneumoniae]]''
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| *''[[Haemophilus influenzae]]''
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| *''[[Klebsiella|Klebsiella spp.]]''
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| *''[[Moraxella catarrhalis]]''
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| *''[[Enterobacter|Enterobacter spp.]]''
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| *''[[Mycobacterium|Mycobacterium spp.]]''
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| *''[[Bacillus anthracis]]''
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| ==Pharmacokinetic behaviour in patients with decreased liver and renal function==
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| Mild, moderate and severe renal dysfunction does not alter [[elimination half-life|half-life]], metabolization or excretion significantly. The same is true to for mild to moderate liver impairment ([[Child-Pugh score|Child-Pugh]] class A and B). Nothing is known about severe liver impairment (Child-Pugh class C).
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| ==Uses==
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| Moxifloxacin can be used to treat respiratory infections including acute [[sinusitis]], acute exacerbations of chronic [[bronchitis]] and [[community-acquired pneumonia]] as well as skin and skin structure infections. Moxifloxacin is also used for the treatment of complicated intra-abdominal infections, as seen in hospitals. Since moxifloxacin is primarily metabolized and eliminated via the hepatic route, moxifloxacin is not indicated for the treatment of urinary tract infections.
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| Moxifloxacin is used as a Second-line agent in [[tuberculosis treatment|tuberculosis]] and may potentially have benefits in reducing treatment duration from its current six month to four months.<ref>{{cite journal | title=Moxifloxacin-containing regimens of reduced duration produce a stable cure in murine tuberculosis | author=Nuermberger EL, Yoshimatsu T, Tyagi S, ''et al.'' | journal=Am J Resp Crit Care Med | volume=170 | pages=1131–34 | year=2004 | doi=10.1164/rccm.200407-885OC }}</ref>
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| In [[ophthalmology]], moxifloxacin is available the form of [[eye drops]], marketed by [[Alcon]] as '''Vigamox®''', to treat [[conjunctiva]]l infections caused by susceptible bacteria and to prevent infection following [[Eye surgery|eye surgeries]] such as [[LASIK]].<ref>{{cite news |last=Kim |first=Terrance |url=http://www.ophmanagement.com/article.aspx?article=85866 |title=Refractive surgery prophylaxis; new options in fluoroquinolones spark a fresh, and ongoing, body of research to be evaluated |publisher=Ophthamology Management |date=2003-09 |accessdate=2007-03-26}}</ref>
| | ==Category== |
| | [[Fluoroquinolone]], fourth generation. |
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| ==Resistance== | | ==US Brand Names== |
| Resistance to moxifloxacin arises in ''Mycobacterium tuberculosis'' if moxifloxacin is used alone instead of in combination with other anti-TB drugs,<ref>{{cite journal | journal=Antimicrob Agents Chemother | year=2005 | pages=3977–79 | volume=49 | issue=9 | doi=10.1128/AAC.49.9.3977-3979.2005 | title=Emergence of fluoroquinolone resistance in ''Mycobacterium tuberculosis'' during contrinuously dosed mocifloxacin monotherapy in a mouse model | author=Ginsburg AS, Sun R, Calamita H, ''et al.'' }}</ref> and this appears to be the explanation for the appearance of moxifloxacin resistance in newly diagnosed TB patients in Baltimore<ref name="Ginsburg2003">{{cite journal | title=Fluoroquinolone resistance in patients with newly diagnosed tuberculosis | author=Ginsburg AS, Hooper N, Parrish N, ''et al.'' | journal=Clin Infect Dis | volume=37 | year=2003 | pages=1448–52 | DOI=10.1086/379328 | id=PMID 14614666 }}</ref> and in Taiwan.<ref name="Wang2006">{{cite journal | author=Wang J-Y, Hsueh P-R, Jan I-S, ''et al.'' | title=Empirical treatment with a fluoroquinolone delays the treatment for tuberculosis and is associated with a poor prognosis in endemic areas | journal=Thorax | year=2006 | volume=61 | pages=903–8 | doi=10.1136/thx.2005.056887 }}</ref> Worryingly, the development of resistance can appear in as short a time as seven days.<ref name="Wang2006"/> This calls into question the first line use of moxifloxacin and other respiratory quinolones first line for the treatment of community-acquired pneumonia in populations where TB is still endemic.
| | AVELOX®, MOXEZA®, VIGAMOX®. |
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| ==Dosage== | | ==FDA Package Insert== |
| The dosage is 400 [[milligram|mg]] daily orally or via [[intravenous infusion]] (1 hour). The duration of treatment depends on the disease and ranges from 5 days in acute [[wikt:exacerbation|exacerbation]]s of [[chronic bronchitis]] to 60 days for post-exposure prophylaxis of anthrax. The bioavailability of moxifloxacin is over 90%<ref>{{cite journal | doi=10.1016/S0149-2918(00)88306-X |
| | ''' [[Moxifloxacin description|Description]]''' |
| year=1997 | title=Absolute bioavailability of moxifloxacin | author=Ballow C, Lettieri J, Agarwal V, ''et al.'' }}</ref> and therefore there are no advantages to using intravenous moxifloxacin when the patient is able to swallow tablets. Bioavailability is markedly reduced, however, when taken with sucralfate or aluminum-containing antacids. The intravenous preparation is not licensed for use in the UK.
| | '''| [[Moxifloxacin clinical pharmacology|Clinical Pharmacology]]''' |
| | | '''| [[Moxifloxacin microbiology|Microbiology]]''' |
| There is no sufficient clinical data about dosage to patients under 18 years of age. In geriatric patients no dose reductions are necessary.
| | '''| [[Moxifloxacin indications and usage|Indications and Usage]]''' |
| | | '''| [[Moxifloxacin contraindications|Contraindications]]''' |
| ==Contraindications==
| | '''| [[Moxifloxacin warnings and precautions|Warnings and Precautions]]''' |
| * Known [[hypersensitivity]] to moxifloxacin,other quinolones, or any other ingredient of the preparation.
| | '''| [[Moxifloxacin adverse reactions|Adverse Reactions]]''' |
| * Patients with history of tendon disorder related to quinolone treatment
| | '''| [[Moxifloxacin overdosage|Overdosage]]''' |
| * Documented QT prolongation
| | '''| [[Moxifloxacin clinical studies|Clinical Studies]]''' |
| | | '''| [[Moxifloxacin dosage and administration|Dosage and Administration]]''' |
| ==Pregnancy and lactation==
| | '''| [[Moxifloxacin how supplied|How Supplied]]''' |
| * Pregnancy : Moxifloxacin has been assigned to class C.
| | '''| [[Moxifloxacin labels and packages|Labels and Packages]]''' |
| * Lactation : Moxifloxacin is found in high concentration in the [[milk]] of [[breastfeeding]] mothers. Either the drug or the breastfeeding should be discontinued.
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| ==Side effects==
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| Possible side effects include [[gastrointestinal tract]] disturbances ([[nausea]], [[vomiting]], [[Anorexia (symptom)|anorexia]], [[bloating]], abdominal pain, [[diarrhea]], and [[pseudomembranous colitis]] caused by ''[[Clostridium difficile]]''), skin reactions (also [[Stevens-Johnson syndrome]]), [[rhabdomyolysis]], and serious heart problems (prolonged [[QT interval]] and [[torsades de pointes]]). Development of [[antibiotic resistance|resistance]] has been noticed as well as rare cases of [[hepatotoxicity]] and [[seizure]]s. [[Tendon]] rupture (including rupture of the [[Achilles tendon]]) can also occur.
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| Moxifloxacin may have a much higher attack rate of ''Clostridium difficile'' than other respiratory quinolones, such as [[levofloxacin]].<ref>{{cite journal | author=von Baum M, Sigge A, Bommer M, ''et al.'' | title=Moxifloxacin prophylaxis in neutropenic patients | journal=J Antimicrob Chemother | year=2006 | volume=58 | issue=4 | pages=891–94 | doi=10.1093/jac/dkl320 }}</ref>
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| ==Interactions==
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| Antacids containing [[aluminium]] or [[magnesium]] [[ion]]s inhibit the absorption of moxifloxacin. Drugs that prolong the [[QT interval]] (e.g. [[pimozide]]) may have an additive effect on QT prolongation and lead to increased risk of ventricular arrhythmias. The INR (International Normalised Ratio) may be increased or decreased in patients treated with [[warfarin]]. A precautionary measure would be to monitor the INR more closely and, if necessary, adjust the anticoagulant dose as necessary.
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| Unlike [[ciprofloxacin]], moxifloxacin has no interactions with warfarin or theophylline.
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| ==Trade names==
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| Topical use:
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| US:
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| * Vigamox® 0.5% ophthalmic preparation (marketed by [[Alcon]])
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| Systemic use:
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| * US: Avelox® (marketed by [[Bayer]])
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| * UK: Avelox® (marketed by [[Bayer]], no intravenous preparation available)
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| ==References== | | ==References== |
| <references/>
| | {{Reflist|2}} |
| | | http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/21277slr018,21085slr023_avelox_lbl.pdf |
| {{QuinoloneAntiBiotics}} | | [[Category:Antibiotics]] |
| | | [[Category:Wikinfect]] |
| [[Category:Fluoroquinolone antibiotics]] | |
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| [[de:Moxifloxacin]] | |
| [[ja:モキシフロキサシン]]
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| [[pl:Moksyfloksacyna]]
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| [[th:มอกซิฟลอกซาซิน]]
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| {{WH}}
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| {{WS}}
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