Moxifloxacin - instructions for use, dose, side effects, contraindications

The drug is an antibiotic from the group of fluoroquinolones, has a bactericidal effect. Moxifloxacin inhibits DNA gyrase (topoisomerase type II of gram-negative microorganisms) and topoisomerase of Gram-positive bacteria. As a result, it disrupts supercoiling and cross-linking of DNA gaps, inhibits DNA synthesis, causes profound morphological changes in the cytoplasm, cell wall and membranes of sensitive microorganisms.

Moxifloxacin blocks enzymes responsible for DNA replication, transcription and repair. Moxifloxacin is active against the following microorganisms: Mycoplasma spp., Chlamydia spp., Legionella spp., Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes (group A), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Escherichia coli, Enterobacter cloacae, Chlamydia pneumoniae, Mycoplasma pneumonia, Streptococcus milleri, Streptococcus mitior, Streptococcus agalactiae, Streptococcus dysgalactiae, Staphylococcus cohnii, Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus, Staphylococcus simulans, Corynebacterium diphtheriae, Bordetella pertussis, Klebsiella oxytoca, Enterobacter aerogenes, Enterobacter agglomerans, Enterobacter intermedius, Enterobacter sakazakii, Proteus mirabilis, Proteus vulgaris, Morganella morganii, Providencia rettgeri, Providencia stuartii, Bacteroides distasonis, Bacteroides eggerthii, Bacteroides fragilis, Bacteroides ovatus, Bacteroides thetaiotaomicron, Bacteroides uniformis, Fusobacterium spp., Porphyromonas spp., Porphyromonas anaerobius, Porphyromonas asaccharolyticus, Porphyromonas magnus, Prevotella spp., Propionibacterium spp., Clostridium perfringens, Clostridium ramosum, Legionella pneumophila, Coxiella burnettii.

Pharmacokinetics:

Quickly and completely absorbed, food intake has little effect on the speed and completeness of absorption, absolute bioavailability is 91%, binding to plasma proteins is 45%. The maximum concentration in the blood plasma after ingestion is reached after 0.5-4 hours. Metabolized to sulfonic compounds and glucuronides, excreted by the kidneys and gastrointestinal tract. The half-life is 12 hours.

Indications:

Infectious diseases of the upper and lower respiratory tract (acute sinusitis, exacerbation of chronic bronchitis, community-acquired pneumonia, skin and soft tissue infections, conjunctivitis bacterial).

ICD-10

X.J00-J06.J01 Acute Sinusitis

X.J10-J18.J13 Pneumonia caused by Streptococcus pneumoniae

X.J10-J18.J14 Pneumonia caused by Haemophilus influenzae [Afanasyev-Pfeiffer's]

X.J10-J18.J15 Bacterial pneumonia, not elsewhere classified

X.J10-J18.J15.0 Pneumonia caused by Klebsiella pneumoniae

X.J10-J18.J15.7 Pneumonia caused by Mycoplasma pneumoniae

X.J10-J18.J16.0 Pneumonia caused by chlamydia

X.J10-J18.J16.8 Pneumonia caused by other specified infectious agents

X.J20-J22.J20 Acute bronchitis

X.J20-J22.J20.1 Acute bronchitis caused by Haemophilus influenzae [Afanasyev-Pfeiffer's]

X.J20-J22.J20.2 Acute bronchitis caused by streptococcus

X.J20-J22.J20.8 Acute bronchitis caused by other specified agents

X.J40-J47.J42 Chronic bronchitis, unspecified

XI.K65-K67.K65 Peritonitis

XII.L00-L08.L01 Impetigo

XII.L00-L08.L02 Abscess of skin, boil and carbuncle

XII.L00-L08.L03 Phlegmon

XII.L00-L08.L08.0 Pyoderma

XII.L00-L08.L08.9 Local infection of skin and subcutaneous tissue, unspecified

Contraindications:

Pregnancy, breast-feeding, age under 18, hypersensitivity, allergic reactions to peanuts or soy, epilepsy, severe diarrhea, tendon damage with prior treatment with quinolones, simultaneous use of drugs that extend the QT interval (moxifloxacin lengthens QT).

Carefully:

Chronic liver diseases.

Diseases of the central nervous system.

Patients with psychoses and psychiatric illnesses in the anamnesis.

Patients with potentially proarrhythmic conditions, such as acute myocardial ischemia.

Myasthenia gravis gravis.

Cirrhosis of the liver.

Simultaneous reception with drugs that reduce the content of potassium.

Pregnancy and lactation:

Category FDA - C. Use in pregnancy is possible if the expected effect of therapy exceeds the potential risk to the fetus (adequate and strictly controlled safety studies in pregnant women have not been conducted).Penetrates into breast milk. Breastfeeding women should stop breastfeeding, or use moxifloxacin (given the importance of the medicine for the mother).

Dosing and Administration:

Inside or intravenously, infusion of 400 mg once a day for 60 minutes. The duration of the course depends on the clinical characteristics of the patient. The course of treatment for exacerbation of chronic bronchitis - 5 days, community-acquired pneumonia - 10 days, acute sinusitis, skin and soft tissue infections - 7 days. The tablet is swallowed whole, without chewing, squeezed with enough water, regardless of the food intake (preferably after eating).

Side effects:

Allergic reactions: urticaria, itching, rash.

From the cardiovascular system: peripheral edema, tachycardia, increased blood pressure, chest pain, palpitations. QT interval prolongation: irregular or slow pulse, repeated fainting; the severity may increase with increasing concentration and speed of intravenous infusion; may increase the risk of ventricular arrhythmias, including flutter / flicker.

From the genitourinary system: vaginitis, vaginal candidiasis, hyperuricemia, impaired renal function.

From the nervous system: anxiety, nervousness, tremor, headache, asthenia, confusion, leg pain, depression, seizures, paresthesia.

From the musculoskeletal system: arthralgia, back pain, myalgia, tendon rupture.

On the part of the hematopoiesis system: eosinophilia, leukopenia, thrombocytopenia, anemia.

From the gastrointestinal tract: diarrhea, nausea, abdominal pain, constipation, flatulence, taste distortion, dyspepsia, vomiting, increased activity of transaminases.

From the laboratory indicators: an increase in the activity of amylase, a decrease in the level of prothrombin.

Overdose:

Not described. Treatment: gastric lavage, activated charcoal can be taken (after an overdose of a solution for intravenous infusion Activated carbon only 20% reduces the system exposure of the drug), adequate hydration, maintenance and symptomatic therapy, ECG monitoring within 24 hours after an overdose (possibly prolongation of the QT interval and other cardiac complications, including arrhythmias).

Interaction:

Mineral substances, antacids, multivitamins reduce the absorption of the drug due to the formation of chelate complexes with polyvalent cations contained in these preparations.

Activated carbon reduces the absorption of moxifloxacin.

Simultaneous reception of the drug with other fluoroquinolones can lead to the appearance of phototoxic reactions and the risk of lengthening the interval QT.

Against the background of moxifloxacin, an interval QT, so caution should be given to patients who receive other drugs at the same time, extending the interval QT (cisapride, erythromycin, antipsychotics, tricyclic antidepressants), since the additive effect can not be ruled out.

With caution appoint against a background of antiarrhythmic drugs Ia class (quinidine, procainamide) or III class (amiodarone, sotalol).

Due to the limited compatibility information, any other drugs should not be added to the moxifloxacin solution or administered simultaneously through a single intravenous catheter.

Moxifloxacin incompatible with 10 and 20% solutions of sodium chloride, 4.2 and 8.4% sodium bicarbonate solution.

With the simultaneous use of moxifloxacin and glucocorticoids, the risk of tendonitis and rupture of tendons increases.

Special instructions:

During treatment with the drug inflammations and tendon ruptures are possible, especially in elderly patients.

Impact on the ability to drive vehicles and manage mechanisms

Due to the effect on the central nervous system and visual impairment, the drug may reduce the ability to concentrate, so it should not be taken when performing work requiring attention and quick psychomotor reactions (including drivers and pilots before the planned trip or flight).

Instructions

Moxifloxacin (Moxifloxacinum)