Is moxifloxacin (a fluoroquinolone antibiotic) effective for treating sinusitis?

From the Guidelines

Moxifloxacin is a viable option for treating sinusitis, particularly in patients who have failed initial therapy or have severe infections, due to its potent activity against common respiratory pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis 1. The effectiveness of moxifloxacin in treating sinusitis can be attributed to its mechanism of action, which involves inhibiting bacterial DNA gyrase and topoisomerase IV, thereby preventing DNA replication in bacteria. Some key points to consider when prescribing moxifloxacin for sinusitis include:

• The typical dosage is 400 mg orally once daily for 5-10 days, with 7 days being standard for acute bacterial sinusitis.
• Moxifloxacin should be reserved for patients who have failed initial therapy, have severe infections, or have allergies to first-line antibiotics.
• First-line treatments for sinusitis typically include amoxicillin (with or without clavulanate) or doxycycline.
• Moxifloxacin carries risks including tendon rupture, peripheral neuropathy, and C. difficile infection, and patients should be advised to complete the full course of antibiotics even if symptoms improve before completion.
• Patients should also be encouraged to stay hydrated, and use saline nasal irrigation and over-the-counter pain relievers as adjunctive treatments. It is essential to weigh the benefits and risks of moxifloxacin in the context of individual patient needs and to use it judiciously to prevent antibiotic resistance, as highlighted by the FDA warnings about serious side effects associated with fluoroquinolones like moxifloxacin 1.

From the FDA Drug Label

14.1 Acute Bacterial Sinusitis

In a controlled double-blind study conducted in the U.S., moxifloxacin hydrochloride tablets (400 mg once daily for ten days) were compared with cefuroxime axetil (250 mg twice daily for ten days) for the treatment of acute bacterial sinusitis. The trial included 457 patients valid for the efficacy analysis Clinical success (cure plus improvement) at the 7 to 21 day post-therapy test of cure visit was 90% for moxifloxacin hydrochloride and 89% for cefuroxime. An additional non-comparative study was conducted to gather bacteriological data and to evaluate microbiological eradication in adult patients treated with moxifloxacin 400 mg once daily for seven days All patients (n = 336) underwent antral puncture in this study. Clinical success rates and eradication/presumed eradication rates at the 21 to 37 day follow-up visit were 97% (29 out of 30) for Streptococcus pneumoniae, 83% (15 out of 18) for Moraxella catarrhalis, and 80% (24 out of 30) for Haemophilus influenzae.

Moxifloxacin is effective for treating sinusitis.

• The clinical success rate for moxifloxacin was 90% in a controlled double-blind study.
• Moxifloxacin demonstrated high eradication rates for common pathogens, including Streptococcus pneumoniae (97%), Moraxella catarrhalis (83%), and Haemophilus influenzae (80%) 2. Key points:
• Moxifloxacin is indicated for the treatment of acute bacterial sinusitis (ABS) caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 2.
• The treatment should be reserved for patients with no alternative treatment options due to the potential for serious adverse reactions.

From the Research

Efficacy of Moxifloxacin in Treating Sinusitis

• Moxifloxacin has been shown to be effective in treating acute maxillary sinusitis after first-line treatment failure and acute sinusitis with high risk of complications, with a clinical success rate of 92.6% 3.
• The bacteriological success rates were 95.7% after 3-4 days of treatment, and 97.2% and 95.2%, in group 1 and group 2, respectively, at 7-10 days post-treatment 3.
• Moxifloxacin has a broad spectrum of antibacterial activity, including activity against penicillin-resistant Streptococcus pneumoniae, and achieves good tissue penetration 4.
• The drug has been found to be distributed extensively throughout the sinuses, in both inflamed and noninflamed mucosae, with tissue-to-blood ratios exceeding 4:1 at most sites 5.

Comparison with Other Antibiotics

• Moxifloxacin has been compared to amoxicillin clavulanate in the treatment of acute maxillary sinusitis, and was found to be statistically equivalent in terms of clinical resolution 6.
• Moxifloxacin was associated with more rapid symptomatic relief, with significantly more patients reporting feeling better by day 3 of treatment 6.
• The frequency of drug-related adverse events was similar between moxifloxacin and amoxicillin/clavulanate, with nausea and diarrhea being the most common adverse events 6.

Safety and Tolerability

• Moxifloxacin has been found to be generally well tolerated, with a low incidence of adverse events, including abdominal pain, nausea, and diarrhea 3, 7.
• The drug has been found to prolong the QT interval, and should be used with caution in patients with proarrhythmic conditions 7.
• Moxifloxacin has limited phototoxic potential, and does not interact with the hepatic cytochrome P-450 isoenzyme system, avoiding many potential drug interactions 7.