Ultramox - instructions for use, doses, side effects, contraindications

Composition:Active ingredient: moxmfloxacin hydrochloride 436.3 mg, calculated as moxifloxacin 400.0 mg.
Excipients: microcrystalline cellulose - 56.2 mg. povidone-K25 27.5 mg, croscarmellose sodium 24.0 mg, magnesium stearate 6.0 mg.
The composition of the capsule body: titanium dioxide - 2.0%, gelatin - up to 100%,
Composition of capsule capsule: titanium dioxide - 2.0%, gelatin - up to 100%.

Description:Capsules hard gelatinous № 00: capsule body white, white cap, opaque.
The contents of the capsules are a mixture of powder and granules from white to light yellow or yellow. Granules of irregular shape, of various sizes, the contents of the capsule can be sealed according to the shape of the capsule.

Pharmacotherapeutic group:Antimicrobial agent - fluoroquinolone.

ATX: & nbsp

J.01.M.A.14 Moxifloxacin

Pharmacodynamics:Moxifloxacin - bactericidal, antibacterial preparation of broad spectrum of action of fluoroquinolone series.The bactericidal effect of the drug is due to the inhibition of bacterial topoisomerases II and IV, which leads to a disruption of the biosynthesis of the DNA of the microbial cell and, as a consequence, to the death of microbial cells.
The minimum bactericidal concentrations of moxifloxacin are generally comparable to its minimum inhibitory concentrations.
Mechanisms that lead to the development of resistance to penicillins, cephalosporins, aminoglycosides, macrolides and tetracyclines do not interfere with the antibacterial activity of moxifloxacin. Cross-resistance between these groups of antibacterial drugs and moxifloxacin is not noted. So far, no cases of plasmid resistance have been observed. The overall frequency of development of resistance
very insignificant (10^-⁷ - 10^-10) . Resistance to moxifloxacin develops slowly by multiple mutations. Multiple effects of moxifloxacin on microorganisms at concentrations below the minimum inhibitory concentration (MIC) are accompanied by only a slight increase in MIC. There are cases of cross-resistance to quinolones. Nevertheless, some gram-positive and anaerobic microorganisms resistant to other quinolones retain sensitivity to moxifloxacin.
It has been established that the addition of the methoxyfloxacin methoxy group in the C8 position to the molecule structure increases the activity of moxifloxacin and reduces the formation of resistant mutant strains of Gram-positive bacteria. The addition of a bicycloamine group at the C7 position prevents the development of an active efflux, a mechanism of resistance to fluoroquinolones.
Moxifloxacin in vitro is active against a wide range of gram-negative and gram-positive microorganisms, anaerobes, acid-fast bacteria and atypical bacteria such as Mycoplasma spp., Chlamydia spp., Legionella spp., And bacteria resistant to β -lactam and macrolide antibiotics.
Effect on human intestinal microflora
In two studies conducted on volunteers, the following changes in the intestinal microflora following oral administration of moxifloxacin were noted: a decrease in the concentrations of Escherichia coli, Bacillus spp., Bacteroides vulgatus, Enterococcus spp., Klebsiella spp., As well as anaerobes Bifidobacterium spp., Eubacterium spp., Peptostreptococcus spp. These changes were reversible within two weeks. No toxins of Clostridium difacile were detected.
In Vitro Sensitivity Testing
The spectrum of antibacterial activity of moxifloxacin includes the following microorganisms:
Gram-positive
Sensitive
Gardnerclla vaginalis, Streptococcus pneumoniae * (including strains resistant to penicillin and strains with multiple antibiotic resistance), as well as strains resistant to two or more antibiotics, such as penicillin (minimum inhibitory concentration (MIC) ≥ 2 μg / ml), second-generation cephalosporins (for example, cefuroxime), macrolides, getracyclines, trimstoprim / sulfamethoxazole) *
Streptucoccus pyogenes (group A) *
Streptococcus milleri (Streptococcus angiosus *, Streptococcus constellatus * Streptococcus intermedins *)
Streptococcus viridans
Streptococcus mulans
Streptococcus mitis
Streptococcus sanguinis
Streptococcus salivarius
Streptococcus thermophilus
Streptococcus constellatus
Streptococcus agalactiae
Streptococcus dysgalactiae
Staphylococcus aureus (including methicillin-sensitive strains) * coagulase-negative staphylococci (Staphylococcus cohnii, Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus saprophyticus, Staphylococcus simulans) strains sensitive to methicillin.
Gram-negative
Haemophilias influenzae (including strains that produce and do not produce β lactamase) *
Haemophilias parainfluenzae *
Moraxella catarrhalis (including strains that produce and do not produce β lactamase) *
Bordetella pertussis
Acinetohacter baumanii
Proteus vulgaris.
Anaerobes
Fusobacterium spp.
Porphyromonas spp.
Prevotella spp.
Propionibacterium spp.
Atypical
Chlamydia pneumoniae *
Mycoplasma pneumoniae *
Legionella pneumophila *
Coxiella burnetii
Chlamydia trachomatis *
Mycoplasma hominis
Mycoplasma genitalium
Moderately sensitive:
Gram-positive
Enterococcus faecalis (strains sensitive to vancomycin and gentamicin only)
Entoreococcus avium *
Enterococcus faecium *
Gram-negative
Escherichia coli *
Klebsiella pneumoniae *
Klebsiella oxytoca
Citrobacter freundii *
Enterobacter spp. (Enterobacter aerogenes, Enterobacter intermedins, Enterobacter sakazakii) Enterobacter cloacae *
Pantoea agglomerans
Pseudomonas fluorescens
Burkholderia cepacia,
Stenotrophomonas maltophilia
Proteus mirabilis *
Morganella morganii
Neisseria gonorrhoeae *
Providencia spp. (Providencia rettgeri, Providencia stuartii).
Anaerobes
Bacteroides spp.(Baderaides fragilis *, Bacteroides distasonis *, Bacteroides thetaiotaomicron *, Bacteroides vulgaris *, Bacteroides ovalus *, Bacteroides uniformis *)
Peploslreptococcus spp. *
Clostridium spp. *
* Sensitivity to moxifloxacin is confirmed by clinical data.
The use of the drug is not recommended for the treatment of infections caused by Staphylococcus aureus strains resistant to methicillin (MRSA). In the case of suspected or confirmed infections caused by MRSA, treatment should be prescribed with appropriate antibacterial drugs.
The following microorganisms are resistant to moxifloxacin:
Staphylococcus aureus (methicillin / ofloxacin resistant strains)
coagulase-negative Staphylococcus spp. (S. cohnii, S. epidermidis, S. haemolyticus, S. hominis, S.saprophyticus, S. simulaus), methicillin-resistant strains of Pseudomonas aeruginosa.
For certain strains, the spread of acquired resistance may vary depending on the geographical region and over time. In this regard, when testing the sensitivity of a strain, it is desirable to have local information on resistance, especially when treating severe infections.

Pharmacokinetics:Absorption and bioavailability
When taken orally moxifloxacin absorbed quickly and almost completely. Absolute bioavailability is about 91%.
The pharmacokinetics of moxifloxacin when administered at a dose of 50 to 1200 mg once, and also at 600 mg / day for 10 days is linear.The equilibrium state is reached within 3 days.
After a single application of 400 mg of moxifloxacin, the maximum concentration (Cmax) in blood plasma is achieved within 0.5-4 hours and is 3.1 mg / l.
When moxifloxacin is taken with food, there is a slight increase in the time to reach Cmax (by 2 hours) and a slight decrease in Cmax (by approximately 16%), while the duration of absorption changes with ns. However, these data have no clinical significance, and the drug can be used regardless of the intake of the poor.
Distribution
Moxifloxacin is rapidly distributed in tissues and organs and binds to blood proteins (mainly albumins) by about 45%. The distribution volume is approximately 2 l / kg.
High concentrations of moxifloxacin, exceeding those in plasma, are created in the lung tissue (including alveolar macrophages), in bronchial mucosa, in nasal sinuses, in exudate from the focus of skin inflammation. In the interstitial fluid and in the saliva moxifloxacin is determined in a free, not protein-related form, in concentration higher than in plasma. In addition, high concentrations of moxifloxacin are determined in the organs of the abdominal cavity and peritoneal fluid, as well as in the tissues of the female genital organs.
Metabolism
After passing the 2nd phase of biotransformation moxifloxacin is excreted from the body by the kidneys and intestines, both in unmodified form and in the form of inactive sulfo compounds and glucuronides. Moxifloxacin does not undergo biotransformation by the microsomal system of cytochrome P450.
Excretion
The half-life of moxifloxacin is approximately 12 hours. Average total The clearance after taking in a dose of 400 mg is from 179 to 246 ml / min. About 22% of a single dose (400 mg) is excreted unchanged by the kidneys, about 26% intestines.
Pharmacokinetics in special clinical cases
Age, gender and ethnicity
When studying the pharmacokinetics of moxifloxacin in men and women, differences in 33% in terms of area under the pharmacokinetic curve of concentration-time (AUC) and Cmax were revealed. Absorption of moxifloxacin did not depend on sex. Differences in AUC and Cmax were due to differences in weight, rather than sex, and are not clinically significant.
There were no clinically significant differences in the pharmacokinetics of moxifloxacin in patients of different ethnic groups and ages.
Children
The pharmacokinetics of moxifloxacin in children have not been studied. Impaired renal function
There were no significant changes in the pharmacokinetics of moxifloxacin in patients with impaired renal function (including patients with creatinine clearance <30 mL / min / 1.73 m²) and in patients on continuous hemodialysis and long-term outpatient peritoneal dialysis.
Impaired liver function
The concentration of moxifloxacin in patients with impaired hepatic function (classes A, B on the Child-Pyo scale) did not differ significantly from that in healthy volunteers or in patients with normal liver function (for use in patients with cirrhosis, see also "Special instructions ").

Indications:Infectious-inflammatory diseases caused by micro-organisms sensitive to moxifloxacin:
- Acute sinusitis
- Community-acquired pneumonia, including community-acquired pneumonia, caused by strains of microorganisms with multiple resistance to antibacterial drugs *
- Exacerbation of chronic bronchitis
- Uncomplicated skin and soft tissue infections
- Complicated skin and soft tissue infections (including an infected diabetic foot)
- Complicated intra-abdominal infections, including polymicrobial infections, including intraperitoneal abscesses.
- Uncomplicated inflammatory diseases of the pelvic organs (including salpingitis and endometritis)
* Streptococcus pneumoniae with multiple resistance, including strains resistant to penicillin, strains resistant to 2 or more antibacterial drugs from groups such as penicillins (with MIC≥ 2 μg / ml), 2 generations of cephalosporins (cefuroxime), macrolides, tetracyclines and trimethoprim / sulfamethoxazole.
It is necessary to take into account the current official guidelines on the rules for the use of antibacterial drugs.

Contraindications:-Increased sensitivity to moxifloxacin, other quinolone drugs and any other component of the drug.
-Year up to 18 years.
-Pregnancy and the period of breastfeeding.
-Treatment of tendons with previously treated quinolones.
- Simultaneous reception of drugs that extend the QT interval (see section "Interaction with other drugs").
- QT interval prolongation: congenital or acquired.
Electrolyte disorders, especially uncorrected hypokalemia.
-Clinically significant bradycardia.
-Clinically significant heart failure with a reduced fraction of the ejection of the left ventricle.
-The presence of a history of cardiac arrhythmias accompanied by clinical symptoms.
-Destruction of liver function (class C according to the Child-Pugh classification) and an increase in the activity of "liver" transaminases is more than five times higher than the upper limit of the norm.

Carefully:In diseases of the central nervous system (CNS) (including suspicious for involvement of the central nervous system), predisposing to the onset of seizures and reducing the threshold of convulsive activity; in patients with potentially proarrhythmic conditions, such as acute myocardial ischemia and cardiac arrest, especially in women and elderly patients; with myasthenia gravis; with cirrhosis of the liver; with simultaneous intake of drugs that reduce the content of potassium; deficiency of glucose-6-phosphate dehydrohease; in patients with psychoses and psychiatric illnesses in the anamnesis.

Dosing and Administration:Inside.
Recommended dosage regimen: one capsule (400 mg) once a day for any of the infections mentioned above. Do not exceed the recommended dose.
Capsule should be taken without chewing with sufficient amount of water, regardless of food intake.
Duration of therapy. The duration of treatment is determined by the localization and severity of the infection, as well as clinical effect.
Exacerbation of chronic bronchitis - 5-10 days.
Community-acquired pneumonia - 7-14 days.
Acute sinusitis - 7 days.
Uncomplicated skin and soft tissue infections - 7 days.
Complicated infections of the skin and soft tissues - 7-21 days.
Complicated intra-abdominal infections - 5-14 days.
Uncomplicated inflammatory diseases of the pelvic organs - 14 days.
Do not exceed the recommended duration of treatment.
Elderly patients
Changes in the dosing regimen in elderly patients are not required.
Children
The efficacy and safety of moxifloxacin in children under 18 years of age is not established.
Violation of the function of the liver (class A and B according to the Chip-Pugh classification)
patients with impaired hepatic function are not required to change the dosage regimen.
Renal insufficiency
In patients with impaired renal function (including renal insufficiency with creatinine clearance <30 ml / min / 1.73 m 2), as well as in patients,patients on continuous hemodialysis and long-term outpatient peritoneal dialysis, changes in the dosing regimen are not required.

Side effects:Data on adverse reactions recorded with the use of moxifloxacin 400 mg (by mouth, with stepwise therapy [intravenous administration and subsequent oral administration] and only intravenously) are obtained from clinical studies and post-marketing reports (italicized).
Adverse reactions listed in the "frequently" group occurred with a frequency below 3%, except for nausea and diarrhea.
In each frequency group, undesirable drug reactions are listed in order of decreasing significance. Frequency of occurrence is defined as follows: very often (> 1/10), often (> 1/100, <1/10), infrequently (> 1/1000, <1/100), rarely (> 1/10000, <1000 ), very rarely (<1/10000), including individual cases, and the frequency is unknown.
Infectious and parasitic diseases: often - fungal superinfections.
On the part of the hematopoiesis system: infrequently - anemia, leukopenia, non-throttling, thrombocytopaedy, thrombocythemia, lengthening prothrombin time / increased internationalnormalized relationship (INR); rarely - change in the concentration of thromboplastin; very rarely - an increase in the concentration of prothrombin / diminished INR.
From the immune system: infrequently - hives, rash, itching, allergic reactions, eosinophilia; rarely anaphylactic / anaphylactoid reactions,
angioedema (including laryngeal edema, potentially life-threatening); very rarely - anaphylactic / anaphylactoid shock (including potentially life-threatening).
From the side of metabolism: infrequently hyperlipidemia; rarely - hyperglycemia, hyperuricemia, hypoglycemia.
Mental disorders: infrequently - a sense of anxiety, psychomotor hyperactivity / agitation; rarely - emotional lability, depression (in very rare cases, behavior with a tendency to self-harm, including suicidal thoughts or suicidal attempts), hallucinations; very rarely - depersonalization, psychotic reactions (potentially manifested in behavior with a tendency to self-harm, including suicidal thoughts or suicidal attempts).
From the nervous system: often - dizziness, headache; infrequently-paresthesia / dysesthesia,a violation of taste sensitivity (including in very rare cases, agevia), confusion, disorientation, sleep disorders, vertigo, tremor, snotty; seldom - hypoesthesia, impaired sense of smell (including anosmia), atypical dreams, impaired coordination (including gait disturbances due to dizziness or vertigo, very rarely leading to trauma from falling, especially in elderly patients), seizures with various clinical manifestations (including including "grand mal" seizures), attention disorders, speech disorders, amnesia, peripheral neuropathy, polyneuropathy; very rarely hyperesthesia.
From the side of the organ of vision: infrequently - visual impairment (especially with CNS reactions); very rarely - transient loss of vision (especially against the backdrop of reactions from the CNS).
From the side of the hearing organ and labyrinthine disorders: rarely - noise in the ears, hearing impairment, including deafness (usually reversible).
From the cardiovascular system: often - prolongation of the QT interval in patients with concomitant hypokalemia; infrequent - prolongation of the QT interval, palpitation, tachycardia, vasodilation ("tides" of blood to the face); rarely, ventricular tachyarrhythmias, fainting, increased blood pressure,lowering blood pressure; very rarely - nonspecific arrhythmias, polymorphic ventricular tachycardia (torsades des pointes), cardiac arrest (mainly in persons with predisposing to arrhythmia states, such as clinically significant bradycardia, acute myocardial ischemia).
From the respiratory system: infrequently - shortness of breath (including asthmatic conditions.
From the gastrointestinal tract: often pain and abdomen, nausea, vomiting, diarrhea; infrequent - reduced appetite and reduced food intake, dyspepsia, flatulence, constipation, gastroenteritis (except erosive gastroenteritis), increased amylase activity; rarely - stomatitis, dysphagia, pseudomembranous colitis (in very rare cases associated with life-threatening complications).
From the liver and bile ducts: often - increased activity of "hepatic" transamiaasis; infrequent liver function disorders (including increased lactate dehydrogenase activity), increased bilirubin concentration, increased activity of gamma-glutamyl transferase, increased alkaline phosphatase activity in blood; rarely - jaundice, hepatitis (mostly cholestatic); rarely -
fulminant hepatitis, potentially leading to life-threatening liver failure (including fatal cases).
From the skin and soft tissues: very rarely - bullous skin reactions, for example, Stevens-Johnson syndrome or toxic epidermal necrolysis (potentially life-threatening).
From the side of the musculoskeletal and connective tissue: infrequently - arthralgia, myalgia; rarely - tendonitis, increased muscle tone and cramps, muscle weakness; very rarely - tendon ruptures, arthritis, gait disturbance due to damage to the musculoskeletal system, increased symptoms of myasthenia gravis.
From the side of the kidneys and urinary tract: infrequently - dehydration (caused by diarrhea or decreased fluid intake), rarely - renal dysfunction, kidney failure (as a result of dehydration, which can lead to kidney damage, especially in elderly patients with concomitant renal dysfunction).
General disorders and disorders at the injection site: often - reactions at the injection / infusion site; infrequent - general malaise, nonspecific pain, sweating, phlebitis / thrombophlebitis in the infusion site: rarely - edema.
The frequency of development of the following adverse reactions was higher in the group receiving the stepwise therapy:
Often: increased activity of gamma-glutamyltransferase.
Infrequent: ventricular tachyarrhythmias, decreased blood pressure, swelling, pseudomembranous colitis (in very rare cases associated with life-threatening complications), seizures with various clinical manifestations (including "grand mal" seizures), hallucinations, impaired renal function, renal insufficiency as a result of dehydration, which can lead to kidney damage, especially in elderly patients with pre-existing impaired renal function).

Overdose:There are limited data on the overdose of moxifloxanin. No side effects were observed with the use of moxifloxanin - in a dose of up to 1200 mg once and 600 mg for 10 days or more. In case of an overdose, one should be guided by the clinical picture and carry out symptomatic maintenance therapy with ECG-mopping. The use of activated carbon at an early stage of absorption prevents further systemic exposure to xifloxacin, which should be considered in the event of an overdose of the drug.

Interaction:Antacids. minerals and multivitamins
The combined use of moxifloxanin and antacid preparations, minerals and multivitamins can impair the absorption of moxifloxanin, due to the formation of chelate complexes with polyvalent cations contained in these preparations, and hence to reduce the concentration of moxifloxanin in the blood plasma. In this regard, antacid, antiretroviral (eg, didyosin) and other drugs containing calcium, magnesium, aluminum, iron, should be taken at least 4 hours before or 4 hours after ingestion of moxifloxanin.
With the simultaneous use of moxifloxanin and glucocorticosteroids, the risk of developing tendovaginitis and rupture of the tendon increases.
It is not necessary to correct the dosage regimen when combined with atenolol, ranitidine, calcium-containing additives, geofillin, oral contraceptives, glibenclamide, itraconazole, digoxin, morphine, probenecid, cyclosporine.
Drugs that extend the QT interval
Consider the possible additive effect of prolonging the QT interval of moxifloxanin and other drugs that affect the prolongation of the QT interval.With the simultaneous use of moxifloxanin with these drugs, the risk of developing ventricular arrhythmia increases, including arrhythmia torsades des pointes. Contraindicated simultaneous use of moxifloxanin with the following drugs that affect the prolongation of the QT interval:
- antiarrhythmic drugs 1A (quinidine, hydrochipidium, disopyramide, etc.) and III (amiodarone, sotalol, dofetil, ibutilide, etc.) classes;
- Tricyclic antidepressants;
- Neuroleptics (phenothiazip, pimozide, sertindole, haloeridol. sul- tonide, etc.);
- antimicrobial drugs (sparfloxacin, erythromycin (intravenously), pentamidine, halofantrine and other antimalarial drugs);
- antihistamines (asgsmizol, terfenadii, misolastine);
-other (pisayrid, viikamine (intravenously), bepridil, difemanyl).
Warfarin
When combined with warfarin prothrombin time and other parameters of blood coagulation do not change. However, in patients receiving anticoagulants in combination with antibiotics, including moxifloxacin, there have been cases of increased anticoagulant activity of anticoagulant drugs.Risk factors are the presence of an infectious disease (and concomitant inflammatory process), the age and general condition of the patient. Despite the fact that the interaction between moxifloxacin and warfarin ns is revealed, in patients receiving concomitant treatment with these drugs, it is necessary to carry out
monitoring the value of INR and, if necessary, adjust the dose of indirect anticoagulants.
Digoxin
Moxifloxacin and digoxin do not significantly affect the pharmacokinetic parameters of each other. When repeated doses of moxifloxacin were used, the maximum digoxin concentration increased by approximately 30%, and the minimum digoxin concentration did not change.
Activated carbon
With the simultaneous use of activated carbon and moxifloxacin inside at a dose of 400 mg, the systemic bioavailability of the drug is reduced by more than 80% as a result of inhibition of its absorption. In the case of an overdose, the use of activated carbon at an early stage of absorption inhibits further increase in systemic exposure.

Special instructions:In some cases, after the first use of the drug may develop hypersensitivity and allergic reactions, which should immediately inform the doctor.Very rarely anaphylactic reactions can progress to a life-threatening anaphylactic shock even after the first use of the drug. In these cases moxifloxacin it is necessary to cancel and conduct the necessary medical measures (including anti-shock).
During treatment with moxifloxacin, inflammation and rupture of the tendon can develop, especially in elderly patients and in patients receiving glucocorticosteroids in parallel. When the first symptoms of pain or inflammation of the tendons should stop taking moxifloxacin and immobilize the affected limb.
When moxifloxacin is used, prolongation of the QT interval may be noted in some patients. The prolongation of the QT interval is associated with an increased risk of developing ventricular arrhythmias, including polymorphic ventricular tachycardia. There is a direct relationship between an increase in the concentration of moxifloxacin and an increase in the QT interval. Therefore, do not exceed the recommended dose (400 mg / day). Elderly patients and women are more sensitive to drugs that extend the QT interval. With the use of moxifloxacin, the risk of developing ventricular arrhythmias in patients with predisposing arrhythmias may increase.In this regard, the drug should not be used in the following cases: prolongation of the QT interval: congenital or acquired; unadjusted hypokalemia; clinically significant bradycardia; clinically significant heart failure with a reduced fraction of the left ventricular ejection; presence in the anamnesis of disturbances of the cardiac rhythm, accompanied by clinical symptoms; simultaneous reception of drugs that extend the QT interval (see section "Interaction with other drugs").
The drug should be used with caution in patients with potentially proarrhythmic conditions, such as acute myocardial ischemia and cardiac arrest; in patients with cirrhosis of the liver (since this category of patients can not exclude the risk of developing an extension of the QT interval).
When moxifloxacin was used, cases of fulminant hepatitis, potentially leading to liver failure, were noted. If symptoms of liver dysfunction occur, such as rapidly growing asthenia, jaundice, darkening of the urine, you should consult a doctor before continuing with the drug.
There have been reports of cases of development of bullous skin lesions (Stevens-Johnson syndrome, toxic epidermal nsrolysis). Patients should be informed that in case of the onset of symptoms of skin lesions or mucous membranes should consult a doctor before you continue treatment with moxifloxacin. The use of broad-spectrum antimicrobials, including moxifloxacin, is associated with a risk of developing pseudomembranous colitis. This diagnosis should be borne in mind in patients who have severe diarrhea in the background of moxifloxacin treatment. In this case, you should cancel the drug and prescribe the appropriate therapy. Drugs that inhibit the peristalsis of the intestine are contraindicated in the development of severe diarrhea.
The use of drugs quinolone series is associated with a possible risk of seizures.
Moxifloxacin should be used with caution in patients with myasthenia gravis in seizure with possible exacerbation of the disease.
It is not recommended to take the drug in patients with complicated inflammatory diseases of the pelvic organs (for example, associated with tubovarial or pelvic abscesses).
The drug does not have a photosensitizing effect, however, during the treatment with the drug, it is recommended to avoid ultraviolet irradiation including. direct sunlight.
It is not recommended to use moxifloxacin for the treatment of infections caused by Staphylococcus aureus strains resistant to methicillin (MRSA). In the case of suspected or confirmed infections caused by MRSA, treatment should be prescribed with appropriate antibacterial drugs.
Because of the wide spread and growing incidence of infections caused by Neuriseria resistant to fluoroquinolones, gonorrhoeae, in patients with pelvic inflammatory disease, monotherapy with mossifloxacin should not be performed. Except in cases where the presence of a resistant to fluoroquinolones, Neisseria gonorrhoeae is excluded. If there is no way to exclude the presence of Neisseria gonorrhoeae resistant to fluoroquinolones, the question of supplementing empirical therapy with moxifloxacin with an appropriate antibiotic that is active against Neisseria gonorrhoeae should be addressed.
When moxifloxacin is used, it is possible to obtain false-negative results in the test for the isolation of Mycobacterium tuberculosis.
In patients receiving fluoroquinolones, including moxifloxacin, sensory or sensorimotor peripheral neuropathy was noted. If the patient has symptoms of neuropathy (pain, burning, tingling, numbness or weakness), the use of moxifloxacin should be discontinued. This minimizes the possible risk of irreversible changes.
Reactions from the psyche may occur even after the first use of moxifloxacin. In very rare cases, depression or psychotic reactions progress to suicidal thoughts and behavior with a tendency to self-harm, including suicidal attempts. If patients develop such reactions, stop taking the drug and take the necessary measures.

Effect on the ability to drive transp. cf. and fur:During the treatment period, one should refrain from driving vehicles and performing potentially hazardous activities requiring increased
concentration of attention and speed of psychomotor reactions.

Form release / dosage:Capsules 400.0 mg.

Packaging:By 5, 7, 10, 20 capsules in a contour mesh box made of polyvinylchloride film and aluminum foil printed lacquered.
For 10, 20, 30, 50, 60 or 120 capsules in cans of polyethylene terephthalate or in cans of polymeric polypropylene for medicines.
One jar or 1, 2, 3, 4, 5 or 10 contour mesh packages together with the instruction for use are placed in a cardboard package (bundle).

Storage conditions:In the dark place at a temperature of no higher than 25 ° C.
Keep out of the reach of children.

Shelf life:3 years.
Do not use the drug after the expiration date.

Terms of leave from pharmacies:On prescription

Registration number:LP-003198

Date of registration:16.09.2015

Expiration Date:16.09.2020

The owner of the registration certificate:OZONE, LLC OZONE, LLC Russia

Manufacturer: & nbsp

OZONE, LLC Russia

Information update date: & nbsp2016-08-21

Illustrated instructions

Instructions

Ultramax (Ultramax)