Moxifloxacin is a synthetic antibiotic medication belonging to the fluoroquinolone class. It is commonly used to treat a variety of bacterial infections. Moxifloxacin works by inhibiting the activity of bacterial DNA gyrase and topoisomerase IV enzymes, which are essential for DNA replication and repair in bacteria. By interfering with these processes, the medication can effectively kill or inhibit the growth of susceptible bacteria.

A newer generation of respiratory quinolone known as moxifloxacin (Avelox) is used to treat a number of bacterial infections of the respiratory tract, pelvis, and abdomen.

Indications of Moxifloxacin (Avelox):

• It is meant for the therapy of:
  • Mild to moderate community-acquired pneumonia, such as that caused by the drug-resistant strain of Streptococcus pneumonia (MDRSP)
  • Acute bacterial bronchitis that has worsened
  • Yersinia pestis plague, including pneumonic and septicemic plague, prevention and therapy.
  • Acute bacterial rhinosinusitis. Complicated and simple skin and skin structure infections.

Limitations of use:

• • Due to potentially fatal adverse effects such as tendinitis and tendon rupture, peripheral neuropathy, and CNS effects, moxifloxacin should only be administered to individuals who have no other alternatives for treating acute exacerbations of chronic bronchitis or acute sinusitis.
• Off Label Use of Moxifloxacin in Adults:
  • Diabetic foot infections
  • Anthrax
  • Bite wounds (animal and human)
  • Meningitis, bacterial
  • Pelvic inflammatory disease
  • Mycoplasma genitalium
  • Nocardiosis
  • Surgical prophylaxis
  • Tuberculosis (second-line therapy)

Moxifloxacin (Avelox) dose in adults:

Moxifloxacin (Avelox) dose in the treatment of Anthrax (off-label):

Inhalation Anthrax (After Exposure):

• Take it by mouth (oral).
• Take 400 milligrams once every 24 hours.
• Continue this treatment for 60 days.

Skin Anthrax (Without Widespread Infection):

• Take it by mouth (oral).
• Take 400 milligrams once every 24 hours.
• Do this for 7 to 10 days if the infection was naturally acquired.
• If the infection is related to bioterrorism, continue for 60 days.

Anthrax with Widespread Infection (Including Infection of the Brain Coverings - Meningitis):

• It's given through a vein (intravenous or IV).
• Receive 400 milligrams once every 24 hours.
• Use it alongside another medicine that stops bacteria from making proteins (like clindamycin or linezolid).
• If meningitis is suspected or can't be ruled out, use it with another medicine that kills bacteria (like a betalactam) and a protein synthesis inhibitor (like clindamycin or linezolid).
• The treatment lasts for 2 weeks if meningitis is ruled out, or until you're stable if meningitis is confirmed.
• If meningitis is possible or confirmed, treatment lasts for at least 2 to 3 weeks.
• If you were exposed to the infection through breathing in spores in the air, you need to take preventive medicine for 60 days from when you got sick.

Moxifloxacin (Avelox) dose in the treatment of Bite wounds (animal or human) (off-label): 

For treating bite wounds (from animals or humans) using Moxifloxacin

• Bite Wounds (Human/Animal):
  • Take it by mouth (oral) or through a vein (IV).
  • If you're allergic to beta-lactam antibiotics, Moxifloxacin can be an alternative.
  • Take 400 milligrams once a day.

For treating worsening of chronic bronchitis caused by bacteria:

• Chronic Bronchitis, Flare-Up due to Bacteria:
  • Take it by mouth (oral) or through a vein (IV).
  • Take 400 milligrams every 24 hours.
  • Continue this for 5 days.

Moxifloxacin (Avelox) dose in the treatment of Community-acquired pneumonia (CAP) (including MDRSP):

For treating community-acquired pneumonia (CAP, which means pneumonia that someone catches outside of a hospital or another healthcare setting), including cases caused by MDRSP (multi-drug resistant Streptococcus pneumoniae):

• Community-acquired pneumonia (CAP):
  • You can take it by mouth (oral) or get it through a vein (IV).
  • Take 400 milligrams once a day.
  • Follow this treatment for 5 days, as recommended by IDSA (Infectious Diseases Society of America) based on a 2007 guideline.

Moxifloxacin (Avelox) dose in the treatment of diabetic foot infection (off-label):

Diabetic Foot Infection:

• Take it by mouth (oral) or get it through a vein (IV).
• Take 400 milligrams once a day, as per the 2009 Vick-Fragoso study.

Moxifloxacin dose in the treatment of complicated Intra-abdominal infections:

Complicated Intra-abdominal Infections:

• Take it by mouth (oral) or get it through a vein (IV).
• Take 400 milligrams once every 24 hours.
• Start with the IV form.
• The treatment can last between 5 to 14 days.
• However, the 2010 IDSA (Infectious Diseases Society of America) guidelines suggest a shorter treatment of 4 to 7 days for mild to moderate infections caught in the community, as long as the source of the infection is under control.

Moxifloxacin dose as an alternative agent in the treatment of Bacterial Meningitis (off-label):

Bacterial Meningitis:

• It's given through a vein (IV).
• Receive 400 milligrams once every 24 hours, as recommended by IDSA (Infectious Diseases Society of America) in both 2004 and 2017 guidelines.
• Some experts also suggest using Moxifloxacin together with either vancomycin or a third-generation cephalosporin, based on the 2017 IDSA guidelines.

Moxifloxacin (Avelox) dose in the therapy of Mycoplasma genitalium (off-label):

Mycoplasma Genitalium Infection:

• Take it by mouth (oral).
• Take 400 milligrams once a day.
• Follow this treatment for either 7, 10, or 14 days, as per studies from Bissessor in 2015 and the CDC's recommendations from 2015.

Moxifloxacin (Avelox) dose in the therapy of Nocardiosis (off-label):

Nocardiosis:

• Take it by mouth (oral) or through a vein (IV).
• Take 400 milligrams once a day.
• Moxifloxacin can be combined with other antimicrobial medicines as suggested by studies from Fihman (2006), Kandasamy (2008), and Tripodi (2011).
• It's worth noting that more research might be needed to fully understand how best to use Moxifloxacin for this condition.

Moxifloxacin dose in the treatment of pelvic inflammatory disease (in patients allergic to cephalosporins) (off-label):

Pelvic Inflammatory Disease:

• Take it by mouth (oral).
• Take 400 milligrams once a day.
• Continue this treatment for 14 days.

However, there are some important points to note:

• The CDC suggests using Moxifloxacin as a backup option. It should be considered only if the usual treatment with a cephalosporin injection isn't possible and if there's a low chance that gonorrhea in the community is resistant to quinolones.
• It's crucial to confirm that the bacteria causing the disease are sensitive to Moxifloxacin through a culture test, as recommended by the CDC in 2015.

Moxifloxacin (Avelox) dose in the therapy of Plague:

Plague:

• You can take it by mouth (oral) or get it through a vein (IV).
• Take 400 milligrams once a day.
• Follow this treatment for 10 to 14 days.

Moxifloxacin (Avelox) Dose as an alternative agent in the treatment of acute bacterial rhinosinusitis:

Acute Bacterial Rhinosinusitis:

• Take it by mouth (oral).
• Take 400 milligrams once a day.
• If it's your first treatment, take it for 5 to 7 days.
• If the first treatment didn't work, then take it for 7 to 10 days.

However, there are some key points to consider:

• For a simple case of bacterial rhinosinusitis, it might be best to wait and see with symptom management instead of taking antibiotics right away.
• Using Moxifloxacin (a fluoroquinolone) for sinusitis is a last-resort option because of significant risks linked to this class of drugs compared to their benefits.
• Although the manufacturer recommends a certain dosage, real-world medical practice may differ. For IV use, the prescribed dose is 400 milligrams every 24 hours.

Moxifloxacin dose in the treatment of Skin and skin structure infections: 

Skin and Skin Structure Infections:

• Complicated Infections:
  • Take it by mouth (oral) or through a vein (IV).
  • Take 400 milligrams once a day.
  • Continue this treatment for 7 to 21 days.
• Uncomplicated Infections:
  • Take it by mouth (oral) or through a vein (IV).
  • Take 400 milligrams once a day.
  • Follow this treatment for 7 days.

Moxifloxacin (Avelox) dose in perioperative surgical prophylaxis:

Surgical Prevention (Perioperative):

• Get it through a vein (IV).
• Receive 400 milligrams no more than 120 minutes (or 2 hours) before the surgery starts, as recommended by Bratzler in 2013.

Moxifloxacin (Avelox) dose in the therapy of drug-resistant tuberculosis or patients intolerant to first-line agents (off-label): 

Tuberculosis (Drug-resistant or Intolerance to First-line Drugs):

• Take it by mouth (oral).
• Take 400 milligrams once a day.
• This recommendation comes from the CDC in 2003.

Moxifloxacin (Avelox) dose in children:

Note:

• When there is no safe and effective alternative (such as in the case of multidrug resistance) or when the only other treatment option is parenteral therapy and moxifloxacin provides an oral therapy option, fluoroquinolones—which are not typically first-line therapy—can be justified as a reasonable alternative.

Moxifloxacin (Avelox) dose in the therapy of Systemic Anthrax (including meningitis):

Note:

• It is administered as a component of triple treatment, with a length of two to three weeks or more until the clinical criteria for stability are reached. Prophylaxis is needed to finish an antimicrobial course that can last up to 60 days from the time of illness.

Babies (3 months and older) and Children under 2 years:

• It's given through a vein (IV).
• The dose is 6 milligrams per kilogram of body weight every 12 hours.
• The maximum dose for each time is 200 milligrams.

Children 2 to 5 years old:

• It's given through a vein (IV).
• The dose is 5 milligrams per kilogram of body weight every 12 hours.
• The maximum dose for each time is 200 milligrams.

Children 6 to 11 years old:

• It's given through a vein (IV).
• The dose is 4 milligrams per kilogram of body weight every 12 hours.
• The maximum dose for each time is 200 milligrams.

Children and Teens 12 to 17 years old:

• If they weigh less than 45 kilograms (about 99 pounds):
  • It's given through a vein (IV).
  • The dose is 4 milligrams per kilogram of body weight every 12 hours.
  • The maximum dose for each time is 200 milligrams.
• If they weigh 45 kilograms or more:
  • It's given through a vein (IV).
  • The dose is 400 milligrams once every 24 hours.

Moxifloxacin (Avelox) dose in the therapy of mild community-acquired Pneumonia or as a step-down therapy:

(CAP caused by M. pneumoniae, C. pneumoniae, and C. trachomatis)

Teenagers with Fully Grown Bones:

• Take it by mouth (oral).
• Take 400 milligrams once a day.

Moxifloxacin dose in the perioperative surgical prophylaxis:

Surgical Prevention (Before Surgery):

• For Children and Teenagers:
  • It's given through a vein (IV).
  • The dose is 10 milligrams for every kilogram of body weight.
  • This should be given no more than 120 minutes (or 2 hours) before the surgery starts.
  • The most any child or teenager should get in one dose is 400 milligrams.

However, there's an important note:

• Even though this type of medicine (fluoroquinolones) can sometimes cause tendon problems, using it just once as a preventative measure is usually safe. But it's not the first choice for children and teenagers. This is based on the guidelines from ASHP/IDSA/SIS/SHEA in 2013.

Moxifloxacin (Avelox) dose in the therapy of multidrug-resistant tuberculosis:

Tuberculosis (Multidrug-Resistant):

Important Points to Note:

• Moxifloxacin should be used with 2 to 3 other anti-TB medicines.
• The exact treatment plan and how long it lasts depend on how the TB bacteria respond to drugs. It's best to refer to the latest guidelines for tuberculosis for detailed information.
• Some recent studies suggest that babies and children might need higher doses compared to adults to achieve the same concentration of the drug in the blood.

Dosages:

• Babies, Children, and Teenagers under 15 years:
  • Can be taken by mouth (oral) or given through a vein (IV).
  • The dose is 10 milligrams for every kilogram of body weight, given once a day.
  • The highest amount they should receive in one dose is 400 milligrams.
• Teenagers 15 years and older:
  • Can be taken by mouth (oral) or given through a vein (IV).
  • The dose is 400 milligrams once a day.

Moxifloxacin (Avelox) Pregnancy Risk Category: C

• Moxifloxacin can pass from a mother to her baby through the placenta, as shown in studies by Ozyüncü and Beksac (2010) and Ozyüncü and Nemutlu (2010).
• Also, because pregnancy causes certain body changes, how moxifloxacin behaves in the body might be different during pregnancy, as mentioned in studies by Nemutlu (2010) and van Kampenhout (2017).

Moxifloxacin use during breastfeeding:

• We're not sure if moxifloxacin gets into breast milk.
• The company that makes the drug says that mothers should think about the possible risks to the baby, the advantages of breastfeeding, and the benefits of the medicine for the mom before deciding to breastfeed while taking it.
• The World Health Organization (WHO) suggests using a different kind of antibiotic if possible, instead of fluoroquinolones like moxifloxacin, in 2002.

Moxifloxacin (Avelox) Dose adjustment in renal disease:

• You don't need to change the dosage of the medication, even if someone has kidney issues or undergoes dialysis treatments.
• Whether it's regular dialysis, dialysis through the abdomen, or continuous dialysis like CVVHD, no extra dose or change in the usual dose is needed.

Moxifloxacin (Avelox) Dose adjustment in liver disease:

You don't need to change the dosage for certain patients, but be careful when using this medicine with them because it might increase the risk of an irregular heart rhythm called QT prolongation.

Side Effects of Moxifloxacin (Avelox):

• Endocrine & Metabolic:
  • Hyperchloremia
  • Increased Serum Albumin
  • Decreased Serum Glucose
  • Hypokalemia
• Central Nervous System:
  • DizzinessHeadache
  • Insomnia
• Hepatic:
  • Decreased Serum Bilirubin
  • Increased Serum Bilirubin
  • Increased Serum Alanine Aminotransferase
• Gastrointestinal:
  • Abdominal Pain
  • Dyspepsia
  • Nausea
  • Constipation
  • Diarrhea
  • Decreased Amylase
  • Vomiting
• Renal:
  • Increased Ionized Serum Calcium
• Respiratory:
  • Hypoxia
• Hematologic & Oncologic:
  • Leukocytosis
  • Prolonged Prothrombin Time
  • Eosinopenia
  • Decreased Basophils
  • Decreased Red Blood Cells
  • Increased MCH
  • Increased Neutrophils
  • Anemia
• Immunologic:
  • Increased Serum Globulins
• Miscellaneous:
  • Fever

Contraindications to Moxifloxacin (Avelox):

Don't use moxifloxacin if you're allergic to it, other similar antibiotics called quinolones, or any ingredient in the medicine.

Warnings and precautions

Modified cardiac conduction

• Fluoroquinolones, like moxifloxacin, might make the heart's QTc interval longer.
• This can be dangerous.
• Don't use these drugs if you have heart rhythm problems, a history of specific dangerous heart rhythms like torsades de pointes, conditions that make heart rhythms more unstable, low potassium or magnesium levels, or if you're taking other medicines that can also lengthen the QT interval.
• This includes certain heart drugs, cisapride, erythromycin, some mental health drugs, and certain types of antidepressants.

Aneurysm of the aorta and dissection

• Fluoroquinolones, a group of drugs that includes moxifloxacin, have been linked to severe problems with the main blood vessel in the heart (aorta) like tears or ruptures, especially within 2 months of taking the medicine.
• This is especially a concern for older people.
• You shouldn't take these drugs if you've had this kind of heart issue before or if you're at higher risk for it, such as having clogged arteries, high blood pressure, certain genetic conditions like Marfan syndrome or Ehlers-Danlos syndrome, or being older in age.
• Only take these drugs if there's no other option.
• Taking them for a long time, like more than 14 days, might increase this risk.

Regulation of Glucose

• Fluoroquinolones, a group of drugs that includes moxifloxacin, can mess with your blood sugar levels, causing them to be too high (hyperglycemia) or too low (hypoglycemia).
• This problem mostly happens in older people or those who are already taking medicine for diabetes.
• Some people have had severe low blood sugar episodes, even leading to a coma or death.
• If you have diabetes, it's important to watch your blood sugar levels closely if you're taking these drugs.
• If you experience a severe drop in blood sugar, stop the drug and get medical treatment right away.

Hepatotoxicity:

• Taking moxifloxacin can, in rare cases, cause a severe liver problem that can lead to liver failure and even death.
• If you're on this medicine and start to feel stomach pain or see signs like yellowing of the skin or eyes (jaundice), very dark urine, or pale stools, stop taking the medicine and contact a doctor right away.
• It's essential to catch and report these symptoms promptly.

Hypersensitivity reactions

• Some people have had severe allergic reactions to quinolone medicines like moxifloxacin.
• These reactions can vary a lot.
• Some might have typical allergy signs like itching or a rash after just one dose, while others can develop more severe skin conditions, lung problems, kidney issues, liver complications, or blood disorders after taking multiple doses.

Photosensitivity

• Moxifloxacin can make you more sensitive to sunlight, which means you might get a sunburn more easily.
• It's best to stay out of strong sunlight while on this medicine.
• If you do go out, wear loose clothes that cover your skin and use sunscreen.
• In rare cases, this drug can cause severe reactions to sunlight.

Warning: Serious adverse reactions

• There's a strong warning about fluoroquinolones, including moxifloxacin.
• These drugs can cause serious problems that might not go away, like issues with tendons, nerve problems in the arms and legs, and brain effects.
• If you experience any of these severe side effects, stop taking moxifloxacin right away and avoid all fluoroquinolones.
• These reactions can happen to anyone, regardless of age or health history, and can start just hours after the first dose or weeks later.

CNS effects

• Fluoroquinolones, like moxifloxacin, can affect the brain and lead to problems like seizures, increased head pressure, feeling lightheaded, dizziness, and shaking.
• These side effects can happen even after the first dose.
• If you experience any of these, stop taking the medicine right away and avoid all fluoroquinolones.
• Be extra careful with this medicine if you already have a brain condition or are at risk of having seizures.

Psychiatric reactions

• Fluoroquinolones, like moxifloxacin, can affect the mind and lead to serious mental reactions.
• This includes seeing or hearing things that aren't there, extreme mistrust, and severe mental confusion.
• It can also cause nervousness, trouble sleeping, feeling anxious, nightmares, forgetfulness, confusion, feeling down, or even thoughts of harming oneself.
• These effects can happen even after just one dose.
• If you experience any of these symptoms, stop taking the drug right away and get medical help.
• Be especially cautious if you have a history of depression or similar conditions.

Peripheral neuropathy:

• Fluoroquinolones, like moxifloxacin, can cause nerve problems that might not go away, affecting areas like your hands and feet.
• These issues can start shortly after beginning the medicine.
• If you feel any unusual sensations or changes in these areas, stop taking the drug.
• Don't use this medicine if you've had nerve problems like this before.

Tendinitis or tendon rupture

• Fluoroquinolones, like moxifloxacin, can increase the risk of tendon problems and even tear the tendon, no matter the age of the patient.
• This risk is higher in people over 60, those taking steroids, and people who've had organ transplants, but it can also happen without these risk factors.
• The Achilles tendon, which connects your heel to your calf, is most commonly affected, but other tendons can also have issues.
• Tendon problems can happen on both sides of the body and can start hours to days after starting the medicine or even months after stopping it.
• Other risk factors include doing a lot of physical activity, having kidney failure, or past tendon problems.
• Stop taking the medicine if you notice any tendon pain, swelling, or other issues.
• Don't use this medicine if you've had tendon problems in the past.

Rheumatoid arthritis:

• If you have rheumatoid arthritis, be careful when using moxifloxacin.
• It could raise your risk of having tendon problems.

Hepatic impairment

• If you have liver problems or liver cirrhosis, be careful when using moxifloxacin.
• It might increase the risk of an irregular heart rhythm called QT prolongation.

Cardiovascular disease

• If you have a slow heartbeat (bradycardia) or issues with reduced blood flow to the heart (acute myocardial ischemia), be careful when using moxifloxacin.

Superinfection

• If you use moxifloxacin for a long time, it might cause a new infection from bacteria or fungi.
• This includes a serious bowel infection caused by C. difficile, which can lead to diarrhea.
• This type of bowel infection can even show up more than two months after you've stopped taking the antibiotic.

Myasthenia gravis: [US Boxed Warning]:

• There's a strong warning about using moxifloxacin if you have myasthenia gravis, a condition that causes muscle weakness.
• Taking this medicine might make the muscle weakness worse.
• If you've had myasthenia gravis before, you shouldn't take this drug.
• In some cases, people's conditions have become so bad that they needed help with breathing or even passed away.

Diabetes:

• If you have diabetes, be careful when using moxifloxacin.
• It might affect your blood sugar levels.

Renal impairment

• If you have kidney problems, be cautious when using moxifloxacin.
• It might increase the risk of tendon problems.

Moxifloxacin (systemic): Drug Interaction

Risk Factor C (Monitor therapy)
Aminolevulinic Acid (Topical)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Topical).
Amphetamines	Quinolones' cardiotoxic effects could be amplified.
BCG Vaccine (Immunization)	Antibiotics may reduce the BCG vaccine's therapeutic efficacy (Immunization).
Blood Glucose Lowering Agents	Blood Glucose Lowering Agents' hypoglycemic effects may be strengthened by quinolones. Blood Glucose Lowering Agents' therapeutic impact may be lessened by quinolones. In particular, the use of quinolones may result in a loss of blood sugar control if an agent is being used to treat diabetes.
Corticosteroids (Systemic	Quinolones' harmful or poisonous effects might be increased. Particularly, there may be an increased risk of tendonitis and tendon rupture.
Haloperidol	may increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Heroin	Quinolones may intensify Heroin's harmful or toxic effects.
Lactobacillus and Estriol	The therapeutic effects of Lactobacillus and Estriol may be reduced by antibiotics.
Methylphenidate	Quinolones' cardiotoxic effects could be amplified.
Mycophenolate	Quinolones may lower the level of mycophenolate in the blood. Quinolones in particular may lower levels of mycophenolate's active metabolite.
Nonsteroidal Anti-Inflammatory Agents	Quinolones' neuroexcitatory and/or seizure-potentiating effects could be enhanced. Quinolones' serum concentration may rise in response to non-steroidal anti-inflammatory drugs.
Ondansetron	may increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Pentamidine (Systemic)	may increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Porfimer	The photosensitizing action of Porfimer may be enhanced by photosensitizing agents.
QT-prolonging Antidepressants (Moderate Risk)	The QTc-prolonging action of QT-prolonging antidepressants may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Antipsychotics (Moderate Risk)	The QTc-prolonging impact of QT-prolonging antipsychotics may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. Examples include pimozide.
QT-prolonging Class IC Antiarrhythmics (Moderate Risk)	The QTc-prolonging impact of QT-prolonging Class IC Antiarrhythmics may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Kinase Inhibitors (Moderate Risk)	The QTc-prolonging impact of QT-prolonging Kinase Inhibitors may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Miscellaneous Agents (Moderate Risk)	May increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. Exceptions: Domperidone.
QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk)	Quinolone antibiotics with a moderate risk of QT prolongation may increase the QTc-prolonging effects of moderate CYP3A4 inhibitors (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Quinolone Antibiotics (Moderate Risk)	May increase the action of other quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk)	Strong CYP3A4 Inhibitors with a QT-prolonging action may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Varenicline	Varenicline's serum levels may rise in response to quinolones. Management: Keep an eye out for any increased varenicline side effects while levofloxacin or other quinolone antibiotics are also being used, especially in patients who have severe renal impairment. Different international standards exist for product labelling. Look up the relevant labels.
Verteporfin	Verteporfin's photosensitizing action may be strengthened by photosensitizing agents.
Vitamin K Antagonists (eg, warfarin)	Quinolones could make Vitamin K antagonists' anticoagulant effects even more potent.
Risk Factor D (Consider therapy modification)
Antacids	Quinolones' absorption could be decreased. a problem only when quinolones are used orally. To lessen the effects of this combination, avoid giving quinolones and antacids at the same time. Optimal dosage separation recommendations differ depending on the particular quinolone. Exceptions: Bicarbonate of sodium
Delamanid	Delamanid's ability to prolong QTc may be enhanced by QT-prolonging quinolone antibiotics (moderate risk). Delamanid may increase the action of Quinolone antibiotics that prolong QTc (Moderate Risk). Management: If at all feasible, avoid using delamanid and quinolone antibiotics concurrently. Electrocardiograms should be frequently checked during the whole delamanid treatment period if coadministration is thought to be inevitable.
Didanosine	Didanosine's serum levels may be reduced by quinolones. Didanosine may lower the level of quinolones in the serum. Treatment: Give oral quinolones at least two hours prior to or six hours following didanosine. Check for diminished quinolone therapeutic effects, especially if dosages cannot be separated as advised. Didanosine with an unbuffered enteric coating is exempt from this rule.
Domperidone	The QTc-prolonging action of Domperidone may be strengthened by QT-prolonging Agents (Moderate Risk). Management: Take into account different pharmacological combinations. If combined, keep an eye out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Iron Preparations	Quinolones' serum concentration can drop. Treatment: Oral quinolones should be used at least a few hours before or after oral iron (8 hours for moxi, 6 hours for cipro/dela, 4 hours for lome, 3 hours for gemi, and 2 hours for levo, nor, oflox, pefloxacin, or nalidixic acid). Iron Carboxymaltose, Iron Gluconate, Iron Hydroxide Polymaltose Complex, Iron Pyrophosphate Citrate, Ferumoxytol, Iron Dextran Complex, Iron Isomaltoside, and Iron Sucrose are exceptions.
Lanthanum	Quinolones' serum concentration can drop. Treatment: Give oral quinolone antibiotics at least an hour before or after lanthanum, whichever comes first.
Magnesium Salts	Quinolones' serum concentration can drop. Treatment: Give oral quinolones before or after oral magnesium salts, depending on the drug (8 h for moxi, 6 h for cipro/dela, 4 h for lome/pe, 3 h for gemi, and 2 h for levo, nor, or ofloxacin or nalidixic acid).
Multivitamins/Minerals (with ADEK, Folate, Iron)	Quinolones' serum concentration can drop. Particularly, oral quinolone antibiotics may be less effectively absorbed when used with polyvalent cations found in multivitamin supplements. Treatment: By taking the oral quinolone at least two hours before or six hours after taking the dose of a multivitamin containing polyvalent cations, interactions can be reduced (i.e., calcium, iron, magnesium, selenium, zinc).
Multivitamins/Minerals (with AE, No Iron)	Quinolones' serum concentration can drop. Particularly, elements in the multivitamin/mineral supplement may hinder quinolone medicines' absorption. Treatment: By taking the oral quinolone at least two hours before or six hours after taking the dose of a multivitamin containing polyvalent cations, interactions can be reduced (i.e., calcium, iron, magnesium, selenium, zinc).
Quinapril	Quinolones' serum concentration can drop. Treatment: To lessen the possibility of an interaction, provide oral quinolones and quinapril at least two hours apart. If both of these medicines are administered at the same time, keep an eye out for any quinolone effectiveness reduction.
Sevelamer	Quinolones' absorption could be decreased. Treatment: Oral quinolones should be taken at least two hours before or six hours after sevelamer.
Sodium Picosulfate	Antibiotics may reduce Sodium Picosulfate's therapeutic impact. Management: If a patient previously used or is currently using an antibiotic, think about utilising an alternate product for bowel cleaning prior to a colonoscopy.
Sucralfate	Quinolones' serum concentration can drop. To lessen the effects of this combination, avoid administering quinolones and sucralfate at the same time. Optimal dosage separation recommendations differ depending on the particular quinolone.
Typhoid Vaccine	The Typhoid Vaccine's therapeutic benefits may be reduced by antibiotics. The only strain impacted is the live attenuated Ty21a strain. Treatment: Patients receiving systemic antibacterial drugs should refrain from receiving the live attenuated typhoid vaccination (Ty21a). It is recommended to wait at least 3 days following the last dose of antibacterial medication before administering this vaccination.
Zinc Salts	Quinolones' serum concentration can drop. Treatment: Oral quinolones should be administered at least a few hours before or after oral zinc salts (8 h for moxi, 6 h for cipro/dela, 4 h for lome, 3 h for gemi, and 2 h for levo, nor, pe, or ofloxacin or nalidixic acid). Exceptions: chloride of zinc.
Risk Factor X (Avoid combination)
Aminolevulinic Acid (Systemic)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Systemic).
BCG (Intravesical)	Antibiotics may lessen BCG's therapeutic effects (Intravesical).
Cholera Vaccine	The therapeutic benefit of the cholera vaccine may be reduced by antibiotic use. Management: Cholera vaccine should not be administered to individuals on systemic antibiotics or within 14 days after taking oral or parenteral antibiotics.
Fexinidazole [INT]	might make QT-prolonging agents' impact on QTc longer (Moderate Risk).
Mequitazine	Mequitazine's ability to induce arrhythmias may be enhanced by moxifloxacin (Systemic).
Nadifloxacin	Quinolones' harmful or poisonous effects might be increased
Pimozide	might make QT-prolonging agents' impact on QTc longer (Moderate Risk)
QT-prolonging Agents (Highest Risk)	May increase Moxifloxacin's ability to extend QTc (Systemic). Delamanian is an exception.
Strontium Ranelate	Quinolones' serum concentration can drop. Management: It is advised that strontium ranelate medication be stopped during quinolone therapy in order to reduce any potential effects of strontium ranelate on quinolone antibiotic concentrations.

Monitoring parameters:

White Blood Cell Count (WBC)

• Monitor the number of white blood cells. They help fight infections, and changes in their count might indicate a health issue.

Signs of Infection

• Look out for symptoms like fever, chills, and fatigue.
• Any unusual pain, swelling, or redness can also be signs.

Blood Sugar Levels

• Monitor for high or low blood sugar signs, like frequent thirst, hunger, or feeling tired or shaky.

Heart Activity for People with Liver Cirrhosis

• Check the heart's electrical activity using an ECG (Electrocardiogram). Liver cirrhosis patients might have heart irregularities.

How to administer Moxifloxacin?

Oral (by mouth)

• You can take it with or without food.
• If you're taking products that contain magnesium, aluminum, iron, or zinc (like some antacids, multivitamins, or certain other medicines), take moxifloxacin either 4 hours before or 8 hours after these products.

IV (in the vein)

• Slowly infuse over an hour.
• Do not give it quickly or all at once.

Mechanism of action of Moxifloxacin (Avelox):

• Moxifloxacin is a type of medicine that stops certain bacterial enzymes from working properly.
• These enzymes are called DNA gyrase and topoisomerase IV.
• They play a vital role in keeping the DNA structure twisted in bacteria.
• DNA gyrase helps with DNA activities like replication and repair.
• When moxifloxacin blocks these enzymes, bacteria can't do these crucial tasks, which ultimately leads to their destruction.
• This effect on bacteria is strong enough to kill them.

Absorption:

• It gets into the body well when taken orally.
• Its absorption isn't affected by foods like fatty meals or yogurt.

Distribution:

• It spreads well in the body. Its volume distribution is between 1.7 to 2.7 L/kg.
• It can be found more in certain tissues like those in the lungs, abdomen, uterus, and sinuses than in the blood.

Binding to Proteins:

• About 30% to 50% of the drug binds to proteins in the blood.

Metabolism (How it's broken down):

• It's processed in the liver.
• About 52% of the drug is transformed in the liver, mostly by attaching to other molecules like glucuronide (14%) and sulfate (38%).

Bioavailability:

• About 90% of the drug becomes available in the body after you take it.

Half-life (Time it takes for half the drug to leave the body):

• After a single dose, it's 12-16 hours for oral intake and 8-15 hours for IV.

Excretion (How it leaves the body):

• It leaves the body mainly through urine and feces.
• 20% is found unchanged in urine and 25% unchanged in feces. The rest are those transformed molecules (glucuronide and sulfate).

International Brands of Moxifloxacin:

• Avelox
• Avelox ABC Pack
• AG-Moxifloxacin
• APO-Moxifloxacin
• Auro-Moxifloxacin
• Avelox
• BIO-Moxifloxacin
• JAMPMoxifloxacin
• M-Moxifloxacin
• Mar-Moxifloxacin
• Priva-Moxifloxacin
• RIVA-Moxifloxacin
• SANDOZ Moxifloxacin
• TEVA-Moxifloxacin
• Avalox
• Avelon
• Avelox
• Axa-Moxin
• Bacterol
• Bancifar
• Cubimox
• Eftimoxin
• Emef
• Evaflox
• Floxsafe
• Garena
• Getmoxy
• Glomoxif
• Idelox
• Innolon
• Izilox
• MFlox
• Maxicin
• Megaxin
• Mofacin
• Moflodal
• Molcin
• Molox
• Moloxcin
• Moloxin
• Mortapp
• Moxaval
• Moxi
• Moxicip
• Moxif
• Moxiflax
• Moxiflo
• Moxiflox
• Moximac
• Moxivig
• MXN
• Oxifled 400
• Pixiriv
• Praxinstad
• Proflox
• Rivomoxi
• Zigat

Moxifloxacin Brand Names in Pakistan:

Moxifloxacin Infusion 400 mg/100ml
Barimox	Barrett Hodgson Pakistan (Pvt) Ltd.
Goldspec	Nimrall Laboratories
Moxan	Hygeia Pharmaceuticals

 

Moxifloxacin Infusion 400 mg/100ml
Barimox	Barrett Hodgson Pakistan (Pvt) Ltd.
Goldspec	Nimrall Laboratories
Moxan	Hygeia Pharmaceuticals

 

Moxifloxacin Drops 0.5 %
Moxilox Drops	Panacea Pharmaceuticals

 

Moxifloxacin Drops 5 % W/V
Inmox	Innvotek Pharmaceuticals

 

Moxifloxacin Eye Drops 5 Mg
Moxbay	Jaens Pharma
Moxirin	Polyfine Chempharma (Pvt) Ltd.

 

Moxifloxacin Eye Drops 1 % W/V
Moxicin	The Schazoo Laboratories Ltd.

 

Moxifloxacin Eye Drops 5 mg/ml
Moxtel	Festel Lab
Moxtel	Festel Lab
Opmox	Ophth-Pharma (Pvt) Ltd.

 

Moxifloxacin Eye Drops 0.5 % W/V
A-Mox	Atco Laboratories Limited
Eyemox	Vega Pharmaceuticals Ltd.
Fotiflox	Helix Pharma (Private) Limited
Inmox	Innvotek Pharmaceuticals
Mexoflox	Azron Pharmaceuticals (Pvt) Ltd
Mionex	Shaigan Pharmaceuticals (Pvt) Ltd
Moxigan	Barrett Hodgson Pakistan (Pvt) Ltd.
Moxiral	Ethical Laboratories (Pvt) Ltd.
Ocumox	Remington Pharmaceutical Industries (Pvt) Ltd.
Omox	Ocu Care
Oxcin	Atco Laboratories Limited
Vigamox	Novartis Pharma (Pak) Ltd

 

Moxifloxacin Eye Drops 5.5 mg//ml
Astron	Epharm Laboratories

 

Moxifloxacin Ear Drops 0.5 % W/V
Moxotic	Hygeia Pharmaceuticals

 

Moxifloxacin Eye Ointment 0.5 % W/W
Ocumox	Remington Pharmaceutical Industries (Pvt) Ltd.

 

Moxifloxacin Tablets 200 mg
Em-Flox	High - Q International
Moxygen	Rogen Pharmaceuticals

 

Moxifloxacin Tablets 400 mg
Abomox	Abbott Laboratories (Pakistan) Limited.
Acflox	W.Woodward Pakistan (Pvt) Ltd.
Aurum	Fozan Pharmaceuticals Industriers (Pvt) Ltd
Avelon	Eg Pharmaceuticals
Avelox	Bayer Health Care
Avemox	Ferroza International Pharmaceuticals (Pvt) Ltd.
Averox	Linear Pharma
Axilent	Envoy Pharma
B-Quin	Akson Pharmaceuticals (Pvt) Ltd.
Bactimox	Valor Pharmaceuticals
Barimox	Barrett Hodgson Pakistan (Pvt) Ltd.
Bemox	Dyson Research Laboratories
Biofloxacin	Medisure Laboratories Pakistan (Pvt.) Ltd.
Biomox	Bio Labs (Pvt) Ltd.
Cinmox	Nexus Pharma (Pvt) Ltd
Devimoh	Don Valley Pharmaceuticals (Pvt) Ltd.
Duramox	Opal Laboratories (Pvt) Ltd.
Em-Flox	High - Q International
Engmox	English Pharmaceuticals Industries
Ezemox	Eastwest Pharma
Fan-C	Caraway Pharmaceuticals
Fimox	Adamjee Pharmaceuticals (Pvt) Ltd.
Floxamox	Lowitt Pharmaceuticals (Pvt) Ltd
Fluxaquin	Bryon Pharmaceuticals (Pvt) Ltd.
Fosty	Tagma Pharma (Pvt) Ltd.
Fotiflox	Helix Pharma (Private) Limited
G-Mox	Reliance Pharma
Genamox	Genera Pharmaceuticals
Glimox	Gillman Pharmaceuticals
Goldspec	Nimrall Laboratories
Imox	Vega Pharmaceuticals Ltd.
Izilon	Bosch Pharmaceuticals (Pvt) Ltd.
Karte	Dr. Raza Pharma (Private) Limited
Lixom Tablet	Raazee Theraputics (Pvt) Ltd.
Locgin	Himont Chemical (Pvt) Ltd.
Loximox	Farmaceutics International
Mactic	Welmark Pharmaceuticals
Maxlox	Searle Pakistan (Pvt.) Ltd.
Maxove	Polyfine Chempharma (Pvt) Ltd.
Meflox	Nabiqasim Industries (Pvt) Ltd.
Metoxim	Genome Pharmaceuticals (Pvt) Ltd
Mflox	Zephyr Pharmatec (Pvt) Ltd.
Mionex	Shaigan Pharmaceuticals (Pvt) Ltd
Mixil	Pharmacare Laboratories (Pvt) Ltd.
Mob	Indus Pharma (Pvt) Ltd.
Mobik	Mass Pharma (Private) Limited
Mocin	Leads Pharma (Pvt) Ltd
Mofest	Sami Pharmaceuticals (Pvt) Ltd.
Mofilox	Macter International (Pvt) Ltd.
Moflex	Wns Field Pharmaceuticals
Moftab	Akhai Pharmaceuticals.
Moksecure	Martin Dow Pharmaceuticals (Pak) Ltd.
Moksi	Abbott Laboratories (Pakistan) Limited.
Molinza	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Molox	Consolidated Chemical Laboratories (Pvt) Ltd.
Mong	Unimark Pharmaceuticals
Mosic	Everest Pharmaceuticals
Mosic	Everest Pharmaceuticals
Mosic	Winilton Pharmaceuticals (Pvt) Ltd
Mox	Maple Pharmaceuticals (Pvt) Ltd
Mox-Q	Hisun Pharmaceuticals
Moxacin	Rakaposhi Pharmaceutical (Pvt) Ltd.
Moxasia	Medera Pharmaceuticals (Pvt) Ltd.
Moxave	Kinsa Pharmaceuticals
Moxi	Aries Pharmaceuticals (Pvt) Ltd
Moxibact	Continental Chemical Company (Pvt) Ltd.
Moxibroad	Usawa Pharmaceuticals
Moxicam	Chas. A. Mendoza
Moxicure	Medifine Laboratories
Moxidix	Neo Medix
Moxidon	Saydon Pharmaceutical Industries (Pvt) Ltd.
Moxifas	Fassgen Pharmaceuticals
Moxiflox	Ottoman Pharma
Moxifo	Tabros Pharma
Moxigene	Genesis Pharmaceuticals (Pvt) Ltd.
Moxiget	Getz Pharma Pakistan (Pvt) Ltd.
Moxigreen	Evergreen Pharmaceuticals Pvt Limited
Moxileck	Medimarkers Pharmaceuticals
Moxilox Table	Spencer Pharma
Moximag	Wise Pharmaceuticals (Pvt) Ltd
Moxina	Amarant Pharmaceuticals (Pvt)
Moxinat	Regent Laboratories Ltd.
Moxione	Max Pharmaceuticals
Moxipulse	Pulse Pharmaceuticals
Moxiqu	Miracle Pharmaceuticals(Pvt) Ltd
Moxirex	Goodman International,
Moxirown	Crown Pharmaceuticals
Moxisave	Medisave Pharmaceuticals
Moxivid	Munawar Pharma (Pvt) Ltd.
Moxiwin	Medicraft Pharmaceuticals (Pvt) Ltd.
Moxizak	Schazoo Zaka
Moxlor	Crest Pharmaceuticals
Moxycare	Csh Pharmaceuticals-North (Pvt) Ltd
Moxygen	Rogen Pharmaceuticals
Moziflox	Weather Folds Pharmaceuticals
Mxil	Pharmacare Laboratories (Pvt) Ltd.
Navelox	Navegal Laboratories
Neumox	Neutro Pharma (Pvt) Ltd.
Occunet	Shrooq Pharmaceuticals
Odequin	Paramount Pharmaceuticals
Osimox	Florence Farmaceuticals (Pvt) Ltd
Otramat	Bloom Pharmaceuticals (Pvt) Ltd.
Oxaquin	Highnoon Laboratories Ltd.
Oxiloc	Noa Hemis Pharmaceuticals
Palzic	Wilshire Laboratories (Pvt) Ltd.
Q-Mox	Hansel Pharmacueutical Pvt (Ltd)
Rapilox	Neophar Health-Care
Romax	Roryan Pharmaceutical Industries (Pvt) Ltd
Romox	Roryan Pharmaceutical Industries (Pvt) Ltd
Rotamox	Rotex Medica Pakistan (Pvt) Ltd
Roximox	Rock Pharmaceuticals
Santomox	Sante (Pvt) Limited
Sapox	Sapient Pharma
Scimox	Scilife Pharma (Private) Ltd
Shalox	Shaheen Pharmaceuticals
Staxin	Standpharm Pakistan (Pvt) Ltd.
Swismox	Swiss Pharmaceuticals (Pvt) Ltd.
Ucit	Unison Chemical Works
Veloxin	Pacific Pharmaceuticals Ltd.
X-Gen	Genix Pharma (Pvt) Ltd
Xefacta	Hilton Pharma (Pvt) Limited
Xemox	K.H. Hoe Farmasiutika, Malaysia
Xenia	Epoch Pharmaceutical

Moxifloxacin is a synthetic antibiotic medication belonging to the fluoroquinolone class. It is commonly used to treat a variety of bacterial infections. Moxifloxacin works by inhibiting the activity of bacterial DNA gyrase and topoisomerase IV enzymes, which are essential for DNA replication and repair in bacteria. By interfering with these processes, the medication can effectively kill or inhibit the growth of susceptible bacteria.

A newer generation of respiratory quinolone known as moxifloxacin (Avelox) is used to treat a number of bacterial infections of the respiratory tract, pelvis, and abdomen.

Indications of Moxifloxacin (Avelox):

• It is meant for the therapy of:
  • Mild to moderate community-acquired pneumonia, such as that caused by the drug-resistant strain of Streptococcus pneumonia (MDRSP)
  • Acute bacterial bronchitis that has worsened
  • Yersinia pestis plague, including pneumonic and septicemic plague, prevention and therapy.
  • Acute bacterial rhinosinusitis. Complicated and simple skin and skin structure infections.

Limitations of use:

• • Due to potentially fatal adverse effects such as tendinitis and tendon rupture, peripheral neuropathy, and CNS effects, moxifloxacin should only be administered to individuals who have no other alternatives for treating acute exacerbations of chronic bronchitis or acute sinusitis.
• Off Label Use of Moxifloxacin in Adults:
  • Diabetic foot infections
  • Anthrax
  • Bite wounds (animal and human)
  • Meningitis, bacterial
  • Pelvic inflammatory disease
  • Mycoplasma genitalium
  • Nocardiosis
  • Surgical prophylaxis
  • Tuberculosis (second-line therapy)

Moxifloxacin (Avelox) dose in adults:

Moxifloxacin (Avelox) dose in the treatment of Anthrax (off-label):

Inhalation Anthrax (After Exposure):

• Take it by mouth (oral).
• Take 400 milligrams once every 24 hours.
• Continue this treatment for 60 days.

Skin Anthrax (Without Widespread Infection):

• Take it by mouth (oral).
• Take 400 milligrams once every 24 hours.
• Do this for 7 to 10 days if the infection was naturally acquired.
• If the infection is related to bioterrorism, continue for 60 days.

Anthrax with Widespread Infection (Including Infection of the Brain Coverings - Meningitis):

• It's given through a vein (intravenous or IV).
• Receive 400 milligrams once every 24 hours.
• Use it alongside another medicine that stops bacteria from making proteins (like clindamycin or linezolid).
• If meningitis is suspected or can't be ruled out, use it with another medicine that kills bacteria (like a betalactam) and a protein synthesis inhibitor (like clindamycin or linezolid).
• The treatment lasts for 2 weeks if meningitis is ruled out, or until you're stable if meningitis is confirmed.
• If meningitis is possible or confirmed, treatment lasts for at least 2 to 3 weeks.
• If you were exposed to the infection through breathing in spores in the air, you need to take preventive medicine for 60 days from when you got sick.

Moxifloxacin (Avelox) dose in the treatment of Bite wounds (animal or human) (off-label): 

For treating bite wounds (from animals or humans) using Moxifloxacin

• Bite Wounds (Human/Animal):
  • Take it by mouth (oral) or through a vein (IV).
  • If you're allergic to beta-lactam antibiotics, Moxifloxacin can be an alternative.
  • Take 400 milligrams once a day.

For treating worsening of chronic bronchitis caused by bacteria:

• Chronic Bronchitis, Flare-Up due to Bacteria:
  • Take it by mouth (oral) or through a vein (IV).
  • Take 400 milligrams every 24 hours.
  • Continue this for 5 days.

Moxifloxacin (Avelox) dose in the treatment of Community-acquired pneumonia (CAP) (including MDRSP):

For treating community-acquired pneumonia (CAP, which means pneumonia that someone catches outside of a hospital or another healthcare setting), including cases caused by MDRSP (multi-drug resistant Streptococcus pneumoniae):

• Community-acquired pneumonia (CAP):
  • You can take it by mouth (oral) or get it through a vein (IV).
  • Take 400 milligrams once a day.
  • Follow this treatment for 5 days, as recommended by IDSA (Infectious Diseases Society of America) based on a 2007 guideline.

Moxifloxacin (Avelox) dose in the treatment of diabetic foot infection (off-label):

Diabetic Foot Infection:

• Take it by mouth (oral) or get it through a vein (IV).
• Take 400 milligrams once a day, as per the 2009 Vick-Fragoso study.

Moxifloxacin dose in the treatment of complicated Intra-abdominal infections:

Complicated Intra-abdominal Infections:

• Take it by mouth (oral) or get it through a vein (IV).
• Take 400 milligrams once every 24 hours.
• Start with the IV form.
• The treatment can last between 5 to 14 days.
• However, the 2010 IDSA (Infectious Diseases Society of America) guidelines suggest a shorter treatment of 4 to 7 days for mild to moderate infections caught in the community, as long as the source of the infection is under control.

Moxifloxacin dose as an alternative agent in the treatment of Bacterial Meningitis (off-label):

Bacterial Meningitis:

• It's given through a vein (IV).
• Receive 400 milligrams once every 24 hours, as recommended by IDSA (Infectious Diseases Society of America) in both 2004 and 2017 guidelines.
• Some experts also suggest using Moxifloxacin together with either vancomycin or a third-generation cephalosporin, based on the 2017 IDSA guidelines.

Moxifloxacin (Avelox) dose in the therapy of Mycoplasma genitalium (off-label):

Mycoplasma Genitalium Infection:

• Take it by mouth (oral).
• Take 400 milligrams once a day.
• Follow this treatment for either 7, 10, or 14 days, as per studies from Bissessor in 2015 and the CDC's recommendations from 2015.

Moxifloxacin (Avelox) dose in the therapy of Nocardiosis (off-label):

Nocardiosis:

• Take it by mouth (oral) or through a vein (IV).
• Take 400 milligrams once a day.
• Moxifloxacin can be combined with other antimicrobial medicines as suggested by studies from Fihman (2006), Kandasamy (2008), and Tripodi (2011).
• It's worth noting that more research might be needed to fully understand how best to use Moxifloxacin for this condition.

Moxifloxacin dose in the treatment of pelvic inflammatory disease (in patients allergic to cephalosporins) (off-label):

Pelvic Inflammatory Disease:

• Take it by mouth (oral).
• Take 400 milligrams once a day.
• Continue this treatment for 14 days.

However, there are some important points to note:

• The CDC suggests using Moxifloxacin as a backup option. It should be considered only if the usual treatment with a cephalosporin injection isn't possible and if there's a low chance that gonorrhea in the community is resistant to quinolones.
• It's crucial to confirm that the bacteria causing the disease are sensitive to Moxifloxacin through a culture test, as recommended by the CDC in 2015.

Moxifloxacin (Avelox) dose in the therapy of Plague:

Plague:

• You can take it by mouth (oral) or get it through a vein (IV).
• Take 400 milligrams once a day.
• Follow this treatment for 10 to 14 days.

Moxifloxacin (Avelox) Dose as an alternative agent in the treatment of acute bacterial rhinosinusitis:

Acute Bacterial Rhinosinusitis:

• Take it by mouth (oral).
• Take 400 milligrams once a day.
• If it's your first treatment, take it for 5 to 7 days.
• If the first treatment didn't work, then take it for 7 to 10 days.

However, there are some key points to consider:

• For a simple case of bacterial rhinosinusitis, it might be best to wait and see with symptom management instead of taking antibiotics right away.
• Using Moxifloxacin (a fluoroquinolone) for sinusitis is a last-resort option because of significant risks linked to this class of drugs compared to their benefits.
• Although the manufacturer recommends a certain dosage, real-world medical practice may differ. For IV use, the prescribed dose is 400 milligrams every 24 hours.

Moxifloxacin dose in the treatment of Skin and skin structure infections: 

Skin and Skin Structure Infections:

• Complicated Infections:
  • Take it by mouth (oral) or through a vein (IV).
  • Take 400 milligrams once a day.
  • Continue this treatment for 7 to 21 days.
• Uncomplicated Infections:
  • Take it by mouth (oral) or through a vein (IV).
  • Take 400 milligrams once a day.
  • Follow this treatment for 7 days.

Moxifloxacin (Avelox) dose in perioperative surgical prophylaxis:

Surgical Prevention (Perioperative):

• Get it through a vein (IV).
• Receive 400 milligrams no more than 120 minutes (or 2 hours) before the surgery starts, as recommended by Bratzler in 2013.

Moxifloxacin (Avelox) dose in the therapy of drug-resistant tuberculosis or patients intolerant to first-line agents (off-label): 

Tuberculosis (Drug-resistant or Intolerance to First-line Drugs):

• Take it by mouth (oral).
• Take 400 milligrams once a day.
• This recommendation comes from the CDC in 2003.

Moxifloxacin (Avelox) dose in children:

Note:

• When there is no safe and effective alternative (such as in the case of multidrug resistance) or when the only other treatment option is parenteral therapy and moxifloxacin provides an oral therapy option, fluoroquinolones—which are not typically first-line therapy—can be justified as a reasonable alternative.

Moxifloxacin (Avelox) dose in the therapy of Systemic Anthrax (including meningitis):

Note:

• It is administered as a component of triple treatment, with a length of two to three weeks or more until the clinical criteria for stability are reached. Prophylaxis is needed to finish an antimicrobial course that can last up to 60 days from the time of illness.

Babies (3 months and older) and Children under 2 years:

• It's given through a vein (IV).
• The dose is 6 milligrams per kilogram of body weight every 12 hours.
• The maximum dose for each time is 200 milligrams.

Children 2 to 5 years old:

• It's given through a vein (IV).
• The dose is 5 milligrams per kilogram of body weight every 12 hours.
• The maximum dose for each time is 200 milligrams.

Children 6 to 11 years old:

• It's given through a vein (IV).
• The dose is 4 milligrams per kilogram of body weight every 12 hours.
• The maximum dose for each time is 200 milligrams.

Children and Teens 12 to 17 years old:

• If they weigh less than 45 kilograms (about 99 pounds):
  • It's given through a vein (IV).
  • The dose is 4 milligrams per kilogram of body weight every 12 hours.
  • The maximum dose for each time is 200 milligrams.
• If they weigh 45 kilograms or more:
  • It's given through a vein (IV).
  • The dose is 400 milligrams once every 24 hours.

Moxifloxacin (Avelox) dose in the therapy of mild community-acquired Pneumonia or as a step-down therapy:

(CAP caused by M. pneumoniae, C. pneumoniae, and C. trachomatis)

Teenagers with Fully Grown Bones:

• Take it by mouth (oral).
• Take 400 milligrams once a day.

Moxifloxacin dose in the perioperative surgical prophylaxis:

Surgical Prevention (Before Surgery):

• For Children and Teenagers:
  • It's given through a vein (IV).
  • The dose is 10 milligrams for every kilogram of body weight.
  • This should be given no more than 120 minutes (or 2 hours) before the surgery starts.
  • The most any child or teenager should get in one dose is 400 milligrams.

However, there's an important note:

• Even though this type of medicine (fluoroquinolones) can sometimes cause tendon problems, using it just once as a preventative measure is usually safe. But it's not the first choice for children and teenagers. This is based on the guidelines from ASHP/IDSA/SIS/SHEA in 2013.

Moxifloxacin (Avelox) dose in the therapy of multidrug-resistant tuberculosis:

Tuberculosis (Multidrug-Resistant):

Important Points to Note:

• Moxifloxacin should be used with 2 to 3 other anti-TB medicines.
• The exact treatment plan and how long it lasts depend on how the TB bacteria respond to drugs. It's best to refer to the latest guidelines for tuberculosis for detailed information.
• Some recent studies suggest that babies and children might need higher doses compared to adults to achieve the same concentration of the drug in the blood.

Dosages:

• Babies, Children, and Teenagers under 15 years:
  • Can be taken by mouth (oral) or given through a vein (IV).
  • The dose is 10 milligrams for every kilogram of body weight, given once a day.
  • The highest amount they should receive in one dose is 400 milligrams.
• Teenagers 15 years and older:
  • Can be taken by mouth (oral) or given through a vein (IV).
  • The dose is 400 milligrams once a day.

Moxifloxacin (Avelox) Pregnancy Risk Category: C

• Moxifloxacin can pass from a mother to her baby through the placenta, as shown in studies by Ozyüncü and Beksac (2010) and Ozyüncü and Nemutlu (2010).
• Also, because pregnancy causes certain body changes, how moxifloxacin behaves in the body might be different during pregnancy, as mentioned in studies by Nemutlu (2010) and van Kampenhout (2017).

Moxifloxacin use during breastfeeding:

• We're not sure if moxifloxacin gets into breast milk.
• The company that makes the drug says that mothers should think about the possible risks to the baby, the advantages of breastfeeding, and the benefits of the medicine for the mom before deciding to breastfeed while taking it.
• The World Health Organization (WHO) suggests using a different kind of antibiotic if possible, instead of fluoroquinolones like moxifloxacin, in 2002.

Moxifloxacin (Avelox) Dose adjustment in renal disease:

• You don't need to change the dosage of the medication, even if someone has kidney issues or undergoes dialysis treatments.
• Whether it's regular dialysis, dialysis through the abdomen, or continuous dialysis like CVVHD, no extra dose or change in the usual dose is needed.

Moxifloxacin (Avelox) Dose adjustment in liver disease:

You don't need to change the dosage for certain patients, but be careful when using this medicine with them because it might increase the risk of an irregular heart rhythm called QT prolongation.

Side Effects of Moxifloxacin (Avelox):

• Endocrine & Metabolic:
  • Hyperchloremia
  • Increased Serum Albumin
  • Decreased Serum Glucose
  • Hypokalemia
• Central Nervous System:
  • DizzinessHeadache
  • Insomnia
• Hepatic:
  • Decreased Serum Bilirubin
  • Increased Serum Bilirubin
  • Increased Serum Alanine Aminotransferase
• Gastrointestinal:
  • Abdominal Pain
  • Dyspepsia
  • Nausea
  • Constipation
  • Diarrhea
  • Decreased Amylase
  • Vomiting
• Renal:
  • Increased Ionized Serum Calcium
• Respiratory:
  • Hypoxia
• Hematologic & Oncologic:
  • Leukocytosis
  • Prolonged Prothrombin Time
  • Eosinopenia
  • Decreased Basophils
  • Decreased Red Blood Cells
  • Increased MCH
  • Increased Neutrophils
  • Anemia
• Immunologic:
  • Increased Serum Globulins
• Miscellaneous:
  • Fever

Contraindications to Moxifloxacin (Avelox):

Don't use moxifloxacin if you're allergic to it, other similar antibiotics called quinolones, or any ingredient in the medicine.

Warnings and precautions

Modified cardiac conduction

• Fluoroquinolones, like moxifloxacin, might make the heart's QTc interval longer.
• This can be dangerous.
• Don't use these drugs if you have heart rhythm problems, a history of specific dangerous heart rhythms like torsades de pointes, conditions that make heart rhythms more unstable, low potassium or magnesium levels, or if you're taking other medicines that can also lengthen the QT interval.
• This includes certain heart drugs, cisapride, erythromycin, some mental health drugs, and certain types of antidepressants.

Aneurysm of the aorta and dissection

• Fluoroquinolones, a group of drugs that includes moxifloxacin, have been linked to severe problems with the main blood vessel in the heart (aorta) like tears or ruptures, especially within 2 months of taking the medicine.
• This is especially a concern for older people.
• You shouldn't take these drugs if you've had this kind of heart issue before or if you're at higher risk for it, such as having clogged arteries, high blood pressure, certain genetic conditions like Marfan syndrome or Ehlers-Danlos syndrome, or being older in age.
• Only take these drugs if there's no other option.
• Taking them for a long time, like more than 14 days, might increase this risk.

Regulation of Glucose

• Fluoroquinolones, a group of drugs that includes moxifloxacin, can mess with your blood sugar levels, causing them to be too high (hyperglycemia) or too low (hypoglycemia).
• This problem mostly happens in older people or those who are already taking medicine for diabetes.
• Some people have had severe low blood sugar episodes, even leading to a coma or death.
• If you have diabetes, it's important to watch your blood sugar levels closely if you're taking these drugs.
• If you experience a severe drop in blood sugar, stop the drug and get medical treatment right away.

Hepatotoxicity:

• Taking moxifloxacin can, in rare cases, cause a severe liver problem that can lead to liver failure and even death.
• If you're on this medicine and start to feel stomach pain or see signs like yellowing of the skin or eyes (jaundice), very dark urine, or pale stools, stop taking the medicine and contact a doctor right away.
• It's essential to catch and report these symptoms promptly.

Hypersensitivity reactions

• Some people have had severe allergic reactions to quinolone medicines like moxifloxacin.
• These reactions can vary a lot.
• Some might have typical allergy signs like itching or a rash after just one dose, while others can develop more severe skin conditions, lung problems, kidney issues, liver complications, or blood disorders after taking multiple doses.

Photosensitivity

• Moxifloxacin can make you more sensitive to sunlight, which means you might get a sunburn more easily.
• It's best to stay out of strong sunlight while on this medicine.
• If you do go out, wear loose clothes that cover your skin and use sunscreen.
• In rare cases, this drug can cause severe reactions to sunlight.

Warning: Serious adverse reactions

• There's a strong warning about fluoroquinolones, including moxifloxacin.
• These drugs can cause serious problems that might not go away, like issues with tendons, nerve problems in the arms and legs, and brain effects.
• If you experience any of these severe side effects, stop taking moxifloxacin right away and avoid all fluoroquinolones.
• These reactions can happen to anyone, regardless of age or health history, and can start just hours after the first dose or weeks later.

CNS effects

• Fluoroquinolones, like moxifloxacin, can affect the brain and lead to problems like seizures, increased head pressure, feeling lightheaded, dizziness, and shaking.
• These side effects can happen even after the first dose.
• If you experience any of these, stop taking the medicine right away and avoid all fluoroquinolones.
• Be extra careful with this medicine if you already have a brain condition or are at risk of having seizures.

Psychiatric reactions

• Fluoroquinolones, like moxifloxacin, can affect the mind and lead to serious mental reactions.
• This includes seeing or hearing things that aren't there, extreme mistrust, and severe mental confusion.
• It can also cause nervousness, trouble sleeping, feeling anxious, nightmares, forgetfulness, confusion, feeling down, or even thoughts of harming oneself.
• These effects can happen even after just one dose.
• If you experience any of these symptoms, stop taking the drug right away and get medical help.
• Be especially cautious if you have a history of depression or similar conditions.

Peripheral neuropathy:

• Fluoroquinolones, like moxifloxacin, can cause nerve problems that might not go away, affecting areas like your hands and feet.
• These issues can start shortly after beginning the medicine.
• If you feel any unusual sensations or changes in these areas, stop taking the drug.
• Don't use this medicine if you've had nerve problems like this before.

Tendinitis or tendon rupture

• Fluoroquinolones, like moxifloxacin, can increase the risk of tendon problems and even tear the tendon, no matter the age of the patient.
• This risk is higher in people over 60, those taking steroids, and people who've had organ transplants, but it can also happen without these risk factors.
• The Achilles tendon, which connects your heel to your calf, is most commonly affected, but other tendons can also have issues.
• Tendon problems can happen on both sides of the body and can start hours to days after starting the medicine or even months after stopping it.
• Other risk factors include doing a lot of physical activity, having kidney failure, or past tendon problems.
• Stop taking the medicine if you notice any tendon pain, swelling, or other issues.
• Don't use this medicine if you've had tendon problems in the past.

Rheumatoid arthritis:

• If you have rheumatoid arthritis, be careful when using moxifloxacin.
• It could raise your risk of having tendon problems.

Hepatic impairment

• If you have liver problems or liver cirrhosis, be careful when using moxifloxacin.
• It might increase the risk of an irregular heart rhythm called QT prolongation.

Cardiovascular disease

• If you have a slow heartbeat (bradycardia) or issues with reduced blood flow to the heart (acute myocardial ischemia), be careful when using moxifloxacin.

Superinfection

• If you use moxifloxacin for a long time, it might cause a new infection from bacteria or fungi.
• This includes a serious bowel infection caused by C. difficile, which can lead to diarrhea.
• This type of bowel infection can even show up more than two months after you've stopped taking the antibiotic.

Myasthenia gravis: [US Boxed Warning]:

• There's a strong warning about using moxifloxacin if you have myasthenia gravis, a condition that causes muscle weakness.
• Taking this medicine might make the muscle weakness worse.
• If you've had myasthenia gravis before, you shouldn't take this drug.
• In some cases, people's conditions have become so bad that they needed help with breathing or even passed away.

Diabetes:

• If you have diabetes, be careful when using moxifloxacin.
• It might affect your blood sugar levels.

Renal impairment

• If you have kidney problems, be cautious when using moxifloxacin.
• It might increase the risk of tendon problems.

Moxifloxacin (systemic): Drug Interaction

Risk Factor C (Monitor therapy)
Aminolevulinic Acid (Topical)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Topical).
Amphetamines	Quinolones' cardiotoxic effects could be amplified.
BCG Vaccine (Immunization)	Antibiotics may reduce the BCG vaccine's therapeutic efficacy (Immunization).
Blood Glucose Lowering Agents	Blood Glucose Lowering Agents' hypoglycemic effects may be strengthened by quinolones. Blood Glucose Lowering Agents' therapeutic impact may be lessened by quinolones. In particular, the use of quinolones may result in a loss of blood sugar control if an agent is being used to treat diabetes.
Corticosteroids (Systemic	Quinolones' harmful or poisonous effects might be increased. Particularly, there may be an increased risk of tendonitis and tendon rupture.
Haloperidol	may increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Heroin	Quinolones may intensify Heroin's harmful or toxic effects.
Lactobacillus and Estriol	The therapeutic effects of Lactobacillus and Estriol may be reduced by antibiotics.
Methylphenidate	Quinolones' cardiotoxic effects could be amplified.
Mycophenolate	Quinolones may lower the level of mycophenolate in the blood. Quinolones in particular may lower levels of mycophenolate's active metabolite.
Nonsteroidal Anti-Inflammatory Agents	Quinolones' neuroexcitatory and/or seizure-potentiating effects could be enhanced. Quinolones' serum concentration may rise in response to non-steroidal anti-inflammatory drugs.
Ondansetron	may increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Pentamidine (Systemic)	may increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Porfimer	The photosensitizing action of Porfimer may be enhanced by photosensitizing agents.
QT-prolonging Antidepressants (Moderate Risk)	The QTc-prolonging action of QT-prolonging antidepressants may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Antipsychotics (Moderate Risk)	The QTc-prolonging impact of QT-prolonging antipsychotics may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. Examples include pimozide.
QT-prolonging Class IC Antiarrhythmics (Moderate Risk)	The QTc-prolonging impact of QT-prolonging Class IC Antiarrhythmics may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Kinase Inhibitors (Moderate Risk)	The QTc-prolonging impact of QT-prolonging Kinase Inhibitors may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Miscellaneous Agents (Moderate Risk)	May increase the action of quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors. Exceptions: Domperidone.
QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk)	Quinolone antibiotics with a moderate risk of QT prolongation may increase the QTc-prolonging effects of moderate CYP3A4 inhibitors (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Quinolone Antibiotics (Moderate Risk)	May increase the action of other quinolone antibiotics that prolong QTc (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk)	Strong CYP3A4 Inhibitors with a QT-prolonging action may be enhanced by QT-prolonging Quinolone Antibiotics (Moderate Risk) (Moderate Risk). When using these medications together, watch out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Varenicline	Varenicline's serum levels may rise in response to quinolones. Management: Keep an eye out for any increased varenicline side effects while levofloxacin or other quinolone antibiotics are also being used, especially in patients who have severe renal impairment. Different international standards exist for product labelling. Look up the relevant labels.
Verteporfin	Verteporfin's photosensitizing action may be strengthened by photosensitizing agents.
Vitamin K Antagonists (eg, warfarin)	Quinolones could make Vitamin K antagonists' anticoagulant effects even more potent.
Risk Factor D (Consider therapy modification)
Antacids	Quinolones' absorption could be decreased. a problem only when quinolones are used orally. To lessen the effects of this combination, avoid giving quinolones and antacids at the same time. Optimal dosage separation recommendations differ depending on the particular quinolone. Exceptions: Bicarbonate of sodium
Delamanid	Delamanid's ability to prolong QTc may be enhanced by QT-prolonging quinolone antibiotics (moderate risk). Delamanid may increase the action of Quinolone antibiotics that prolong QTc (Moderate Risk). Management: If at all feasible, avoid using delamanid and quinolone antibiotics concurrently. Electrocardiograms should be frequently checked during the whole delamanid treatment period if coadministration is thought to be inevitable.
Didanosine	Didanosine's serum levels may be reduced by quinolones. Didanosine may lower the level of quinolones in the serum. Treatment: Give oral quinolones at least two hours prior to or six hours following didanosine. Check for diminished quinolone therapeutic effects, especially if dosages cannot be separated as advised. Didanosine with an unbuffered enteric coating is exempt from this rule.
Domperidone	The QTc-prolonging action of Domperidone may be strengthened by QT-prolonging Agents (Moderate Risk). Management: Take into account different pharmacological combinations. If combined, keep an eye out for cardiac arrhythmias and a prolonged QTc interval. Patients may be considerably more at risk for QTc prolongation if they have additional risk factors.
Iron Preparations	Quinolones' serum concentration can drop. Treatment: Oral quinolones should be used at least a few hours before or after oral iron (8 hours for moxi, 6 hours for cipro/dela, 4 hours for lome, 3 hours for gemi, and 2 hours for levo, nor, oflox, pefloxacin, or nalidixic acid). Iron Carboxymaltose, Iron Gluconate, Iron Hydroxide Polymaltose Complex, Iron Pyrophosphate Citrate, Ferumoxytol, Iron Dextran Complex, Iron Isomaltoside, and Iron Sucrose are exceptions.
Lanthanum	Quinolones' serum concentration can drop. Treatment: Give oral quinolone antibiotics at least an hour before or after lanthanum, whichever comes first.
Magnesium Salts	Quinolones' serum concentration can drop. Treatment: Give oral quinolones before or after oral magnesium salts, depending on the drug (8 h for moxi, 6 h for cipro/dela, 4 h for lome/pe, 3 h for gemi, and 2 h for levo, nor, or ofloxacin or nalidixic acid).
Multivitamins/Minerals (with ADEK, Folate, Iron)	Quinolones' serum concentration can drop. Particularly, oral quinolone antibiotics may be less effectively absorbed when used with polyvalent cations found in multivitamin supplements. Treatment: By taking the oral quinolone at least two hours before or six hours after taking the dose of a multivitamin containing polyvalent cations, interactions can be reduced (i.e., calcium, iron, magnesium, selenium, zinc).
Multivitamins/Minerals (with AE, No Iron)	Quinolones' serum concentration can drop. Particularly, elements in the multivitamin/mineral supplement may hinder quinolone medicines' absorption. Treatment: By taking the oral quinolone at least two hours before or six hours after taking the dose of a multivitamin containing polyvalent cations, interactions can be reduced (i.e., calcium, iron, magnesium, selenium, zinc).
Quinapril	Quinolones' serum concentration can drop. Treatment: To lessen the possibility of an interaction, provide oral quinolones and quinapril at least two hours apart. If both of these medicines are administered at the same time, keep an eye out for any quinolone effectiveness reduction.
Sevelamer	Quinolones' absorption could be decreased. Treatment: Oral quinolones should be taken at least two hours before or six hours after sevelamer.
Sodium Picosulfate	Antibiotics may reduce Sodium Picosulfate's therapeutic impact. Management: If a patient previously used or is currently using an antibiotic, think about utilising an alternate product for bowel cleaning prior to a colonoscopy.
Sucralfate	Quinolones' serum concentration can drop. To lessen the effects of this combination, avoid administering quinolones and sucralfate at the same time. Optimal dosage separation recommendations differ depending on the particular quinolone.
Typhoid Vaccine	The Typhoid Vaccine's therapeutic benefits may be reduced by antibiotics. The only strain impacted is the live attenuated Ty21a strain. Treatment: Patients receiving systemic antibacterial drugs should refrain from receiving the live attenuated typhoid vaccination (Ty21a). It is recommended to wait at least 3 days following the last dose of antibacterial medication before administering this vaccination.
Zinc Salts	Quinolones' serum concentration can drop. Treatment: Oral quinolones should be administered at least a few hours before or after oral zinc salts (8 h for moxi, 6 h for cipro/dela, 4 h for lome, 3 h for gemi, and 2 h for levo, nor, pe, or ofloxacin or nalidixic acid). Exceptions: chloride of zinc.
Risk Factor X (Avoid combination)
Aminolevulinic Acid (Systemic)	Aminolevulinic Acid's photosensitizing impact may be enhanced by photosensitizing agents (Systemic).
BCG (Intravesical)	Antibiotics may lessen BCG's therapeutic effects (Intravesical).
Cholera Vaccine	The therapeutic benefit of the cholera vaccine may be reduced by antibiotic use. Management: Cholera vaccine should not be administered to individuals on systemic antibiotics or within 14 days after taking oral or parenteral antibiotics.
Fexinidazole [INT]	might make QT-prolonging agents' impact on QTc longer (Moderate Risk).
Mequitazine	Mequitazine's ability to induce arrhythmias may be enhanced by moxifloxacin (Systemic).
Nadifloxacin	Quinolones' harmful or poisonous effects might be increased
Pimozide	might make QT-prolonging agents' impact on QTc longer (Moderate Risk)
QT-prolonging Agents (Highest Risk)	May increase Moxifloxacin's ability to extend QTc (Systemic). Delamanian is an exception.
Strontium Ranelate	Quinolones' serum concentration can drop. Management: It is advised that strontium ranelate medication be stopped during quinolone therapy in order to reduce any potential effects of strontium ranelate on quinolone antibiotic concentrations.

Monitoring parameters:

White Blood Cell Count (WBC)

• Monitor the number of white blood cells. They help fight infections, and changes in their count might indicate a health issue.

Signs of Infection

• Look out for symptoms like fever, chills, and fatigue.
• Any unusual pain, swelling, or redness can also be signs.

Blood Sugar Levels

• Monitor for high or low blood sugar signs, like frequent thirst, hunger, or feeling tired or shaky.

Heart Activity for People with Liver Cirrhosis

• Check the heart's electrical activity using an ECG (Electrocardiogram). Liver cirrhosis patients might have heart irregularities.

How to administer Moxifloxacin?

Oral (by mouth)

• You can take it with or without food.
• If you're taking products that contain magnesium, aluminum, iron, or zinc (like some antacids, multivitamins, or certain other medicines), take moxifloxacin either 4 hours before or 8 hours after these products.

IV (in the vein)

• Slowly infuse over an hour.
• Do not give it quickly or all at once.

Mechanism of action of Moxifloxacin (Avelox):

• Moxifloxacin is a type of medicine that stops certain bacterial enzymes from working properly.
• These enzymes are called DNA gyrase and topoisomerase IV.
• They play a vital role in keeping the DNA structure twisted in bacteria.
• DNA gyrase helps with DNA activities like replication and repair.
• When moxifloxacin blocks these enzymes, bacteria can't do these crucial tasks, which ultimately leads to their destruction.
• This effect on bacteria is strong enough to kill them.

Absorption:

• It gets into the body well when taken orally.
• Its absorption isn't affected by foods like fatty meals or yogurt.

Distribution:

• It spreads well in the body. Its volume distribution is between 1.7 to 2.7 L/kg.
• It can be found more in certain tissues like those in the lungs, abdomen, uterus, and sinuses than in the blood.

Binding to Proteins:

• About 30% to 50% of the drug binds to proteins in the blood.

Metabolism (How it's broken down):

• It's processed in the liver.
• About 52% of the drug is transformed in the liver, mostly by attaching to other molecules like glucuronide (14%) and sulfate (38%).

Bioavailability:

• About 90% of the drug becomes available in the body after you take it.

Half-life (Time it takes for half the drug to leave the body):

• After a single dose, it's 12-16 hours for oral intake and 8-15 hours for IV.

Excretion (How it leaves the body):

• It leaves the body mainly through urine and feces.
• 20% is found unchanged in urine and 25% unchanged in feces. The rest are those transformed molecules (glucuronide and sulfate).

International Brands of Moxifloxacin:

• Avelox
• Avelox ABC Pack
• AG-Moxifloxacin
• APO-Moxifloxacin
• Auro-Moxifloxacin
• Avelox
• BIO-Moxifloxacin
• JAMPMoxifloxacin
• M-Moxifloxacin
• Mar-Moxifloxacin
• Priva-Moxifloxacin
• RIVA-Moxifloxacin
• SANDOZ Moxifloxacin
• TEVA-Moxifloxacin
• Avalox
• Avelon
• Avelox
• Axa-Moxin
• Bacterol
• Bancifar
• Cubimox
• Eftimoxin
• Emef
• Evaflox
• Floxsafe
• Garena
• Getmoxy
• Glomoxif
• Idelox
• Innolon
• Izilox
• MFlox
• Maxicin
• Megaxin
• Mofacin
• Moflodal
• Molcin
• Molox
• Moloxcin
• Moloxin
• Mortapp
• Moxaval
• Moxi
• Moxicip
• Moxif
• Moxiflax
• Moxiflo
• Moxiflox
• Moximac
• Moxivig
• MXN
• Oxifled 400
• Pixiriv
• Praxinstad
• Proflox
• Rivomoxi
• Zigat

Moxifloxacin Brand Names in Pakistan:

Moxifloxacin Infusion 400 mg/100ml
Barimox	Barrett Hodgson Pakistan (Pvt) Ltd.
Goldspec	Nimrall Laboratories
Moxan	Hygeia Pharmaceuticals

Moxifloxacin Infusion 400 mg/100ml
Barimox	Barrett Hodgson Pakistan (Pvt) Ltd.
Goldspec	Nimrall Laboratories
Moxan	Hygeia Pharmaceuticals

Moxifloxacin Drops 0.5 %
Moxilox Drops	Panacea Pharmaceuticals

Moxifloxacin Drops 5 % W/V
Inmox	Innvotek Pharmaceuticals

Moxifloxacin Eye Drops 5 Mg
Moxbay	Jaens Pharma
Moxirin	Polyfine Chempharma (Pvt) Ltd.

Moxifloxacin Eye Drops 1 % W/V
Moxicin	The Schazoo Laboratories Ltd.

Moxifloxacin Eye Drops 5 mg/ml
Moxtel	Festel Lab
Moxtel	Festel Lab
Opmox	Ophth-Pharma (Pvt) Ltd.

Moxifloxacin Eye Drops 0.5 % W/V
A-Mox	Atco Laboratories Limited
Eyemox	Vega Pharmaceuticals Ltd.
Fotiflox	Helix Pharma (Private) Limited
Inmox	Innvotek Pharmaceuticals
Mexoflox	Azron Pharmaceuticals (Pvt) Ltd
Mionex	Shaigan Pharmaceuticals (Pvt) Ltd
Moxigan	Barrett Hodgson Pakistan (Pvt) Ltd.
Moxiral	Ethical Laboratories (Pvt) Ltd.
Ocumox	Remington Pharmaceutical Industries (Pvt) Ltd.
Omox	Ocu Care
Oxcin	Atco Laboratories Limited
Vigamox	Novartis Pharma (Pak) Ltd

Moxifloxacin Eye Drops 5.5 mg//ml
Astron	Epharm Laboratories

Moxifloxacin Ear Drops 0.5 % W/V
Moxotic	Hygeia Pharmaceuticals

Moxifloxacin Eye Ointment 0.5 % W/W
Ocumox	Remington Pharmaceutical Industries (Pvt) Ltd.

Moxifloxacin Tablets 200 mg
Em-Flox	High - Q International
Moxygen	Rogen Pharmaceuticals

Moxifloxacin Tablets 400 mg
Abomox	Abbott Laboratories (Pakistan) Limited.
Acflox	W.Woodward Pakistan (Pvt) Ltd.
Aurum	Fozan Pharmaceuticals Industriers (Pvt) Ltd
Avelon	Eg Pharmaceuticals
Avelox	Bayer Health Care
Avemox	Ferroza International Pharmaceuticals (Pvt) Ltd.
Averox	Linear Pharma
Axilent	Envoy Pharma
B-Quin	Akson Pharmaceuticals (Pvt) Ltd.
Bactimox	Valor Pharmaceuticals
Barimox	Barrett Hodgson Pakistan (Pvt) Ltd.
Bemox	Dyson Research Laboratories
Biofloxacin	Medisure Laboratories Pakistan (Pvt.) Ltd.
Biomox	Bio Labs (Pvt) Ltd.
Cinmox	Nexus Pharma (Pvt) Ltd
Devimoh	Don Valley Pharmaceuticals (Pvt) Ltd.
Duramox	Opal Laboratories (Pvt) Ltd.
Em-Flox	High - Q International
Engmox	English Pharmaceuticals Industries
Ezemox	Eastwest Pharma
Fan-C	Caraway Pharmaceuticals
Fimox	Adamjee Pharmaceuticals (Pvt) Ltd.
Floxamox	Lowitt Pharmaceuticals (Pvt) Ltd
Fluxaquin	Bryon Pharmaceuticals (Pvt) Ltd.
Fosty	Tagma Pharma (Pvt) Ltd.
Fotiflox	Helix Pharma (Private) Limited
G-Mox	Reliance Pharma
Genamox	Genera Pharmaceuticals
Glimox	Gillman Pharmaceuticals
Goldspec	Nimrall Laboratories
Imox	Vega Pharmaceuticals Ltd.
Izilon	Bosch Pharmaceuticals (Pvt) Ltd.
Karte	Dr. Raza Pharma (Private) Limited
Lixom Tablet	Raazee Theraputics (Pvt) Ltd.
Locgin	Himont Chemical (Pvt) Ltd.
Loximox	Farmaceutics International
Mactic	Welmark Pharmaceuticals
Maxlox	Searle Pakistan (Pvt.) Ltd.
Maxove	Polyfine Chempharma (Pvt) Ltd.
Meflox	Nabiqasim Industries (Pvt) Ltd.
Metoxim	Genome Pharmaceuticals (Pvt) Ltd
Mflox	Zephyr Pharmatec (Pvt) Ltd.
Mionex	Shaigan Pharmaceuticals (Pvt) Ltd
Mixil	Pharmacare Laboratories (Pvt) Ltd.
Mob	Indus Pharma (Pvt) Ltd.
Mobik	Mass Pharma (Private) Limited
Mocin	Leads Pharma (Pvt) Ltd
Mofest	Sami Pharmaceuticals (Pvt) Ltd.
Mofilox	Macter International (Pvt) Ltd.
Moflex	Wns Field Pharmaceuticals
Moftab	Akhai Pharmaceuticals.
Moksecure	Martin Dow Pharmaceuticals (Pak) Ltd.
Moksi	Abbott Laboratories (Pakistan) Limited.
Molinza	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Molox	Consolidated Chemical Laboratories (Pvt) Ltd.
Mong	Unimark Pharmaceuticals
Mosic	Everest Pharmaceuticals
Mosic	Everest Pharmaceuticals
Mosic	Winilton Pharmaceuticals (Pvt) Ltd
Mox	Maple Pharmaceuticals (Pvt) Ltd
Mox-Q	Hisun Pharmaceuticals
Moxacin	Rakaposhi Pharmaceutical (Pvt) Ltd.
Moxasia	Medera Pharmaceuticals (Pvt) Ltd.
Moxave	Kinsa Pharmaceuticals
Moxi	Aries Pharmaceuticals (Pvt) Ltd
Moxibact	Continental Chemical Company (Pvt) Ltd.
Moxibroad	Usawa Pharmaceuticals
Moxicam	Chas. A. Mendoza
Moxicure	Medifine Laboratories
Moxidix	Neo Medix
Moxidon	Saydon Pharmaceutical Industries (Pvt) Ltd.
Moxifas	Fassgen Pharmaceuticals
Moxiflox	Ottoman Pharma
Moxifo	Tabros Pharma
Moxigene	Genesis Pharmaceuticals (Pvt) Ltd.
Moxiget	Getz Pharma Pakistan (Pvt) Ltd.
Moxigreen	Evergreen Pharmaceuticals Pvt Limited
Moxileck	Medimarkers Pharmaceuticals
Moxilox Table	Spencer Pharma
Moximag	Wise Pharmaceuticals (Pvt) Ltd
Moxina	Amarant Pharmaceuticals (Pvt)
Moxinat	Regent Laboratories Ltd.
Moxione	Max Pharmaceuticals
Moxipulse	Pulse Pharmaceuticals
Moxiqu	Miracle Pharmaceuticals(Pvt) Ltd
Moxirex	Goodman International,
Moxirown	Crown Pharmaceuticals
Moxisave	Medisave Pharmaceuticals
Moxivid	Munawar Pharma (Pvt) Ltd.
Moxiwin	Medicraft Pharmaceuticals (Pvt) Ltd.
Moxizak	Schazoo Zaka
Moxlor	Crest Pharmaceuticals
Moxycare	Csh Pharmaceuticals-North (Pvt) Ltd
Moxygen	Rogen Pharmaceuticals
Moziflox	Weather Folds Pharmaceuticals
Mxil	Pharmacare Laboratories (Pvt) Ltd.
Navelox	Navegal Laboratories
Neumox	Neutro Pharma (Pvt) Ltd.
Occunet	Shrooq Pharmaceuticals
Odequin	Paramount Pharmaceuticals
Osimox	Florence Farmaceuticals (Pvt) Ltd
Otramat	Bloom Pharmaceuticals (Pvt) Ltd.
Oxaquin	Highnoon Laboratories Ltd.
Oxiloc	Noa Hemis Pharmaceuticals
Palzic	Wilshire Laboratories (Pvt) Ltd.
Q-Mox	Hansel Pharmacueutical Pvt (Ltd)
Rapilox	Neophar Health-Care
Romax	Roryan Pharmaceutical Industries (Pvt) Ltd
Romox	Roryan Pharmaceutical Industries (Pvt) Ltd
Rotamox	Rotex Medica Pakistan (Pvt) Ltd
Roximox	Rock Pharmaceuticals
Santomox	Sante (Pvt) Limited
Sapox	Sapient Pharma
Scimox	Scilife Pharma (Private) Ltd
Shalox	Shaheen Pharmaceuticals
Staxin	Standpharm Pakistan (Pvt) Ltd.
Swismox	Swiss Pharmaceuticals (Pvt) Ltd.
Ucit	Unison Chemical Works
Veloxin	Pacific Pharmaceuticals Ltd.
X-Gen	Genix Pharma (Pvt) Ltd
Xefacta	Hilton Pharma (Pvt) Limited
Xemox	K.H. Hoe Farmasiutika, Malaysia
Xenia	Epoch Pharmaceutical