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moxifloxacin
generic
Black Box Warnings .
Disabling, Potentially Irreversible Serious Reactions
fluoroquinolones assoc. 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 pts >60 yo, pts taking corticosteroids, and pts w/ kidney, heart, or lung transplant; D/C immediately and avoid fluoroquinolone use in pts w/ these serious reactions
Avoid in Myasthenia Gravis
fluoroquinolones may exacerbate muscle weakness in pts w/ myasthenia gravis
Reserve Fluoroquinolone Use
for pts w/ 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 pts w/ no alternative tx options
sinusitis, acute bacterial
- [400 mg PO/IV q24h x5-10 days]
- Info: for pts w/ no alternative tx options
PID (off-label)
- [400 mg PO/IV q24h x14 days]
- Info: for pts w/ cephalosporin allergy and low gonorrhea risk; give w/ 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 women; switch to PO abx 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 women; 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 w/ anthrax vaccine; may use in pregnant women; may give x42 days or x14 days after last vaccine dose in immunocompetent pts 18-65 yo if anthrax vaccine regimen completed
leprosy (Hansen dz), multibacillary (off-label)
- [pts 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
- [pts 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 dz), paucibacillary (off-label)
- [pts 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 w/ 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 w/ skeletal maturity]
- Dose: 400 mg PO q24h x7-10 days
PID (off-label)
- [adolescents]
- Dose: 400 mg PO/IV q24h x14 days; Info: for pts w/ cephalosporin allergy and low gonorrhea risk; give w/ 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 abx 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 abx 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 abx 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 abx 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 abx 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 abx x60 days total if inhalational exposure
leprosy (Hansen dz), multibacillary (off-label)
- [15 yo and older, pts 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, pts 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 dz), paucibacillary (off-label)
- [15 yo and older, pts 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]