What infections does moxifloxacin treat?

Moxifloxacin Treatment Indications

Moxifloxacin is FDA-approved for treating community-acquired pneumonia, acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, uncomplicated and complicated skin/skin structure infections, complicated intra-abdominal infections, and plague. 1

FDA-Approved Indications

Moxifloxacin is specifically indicated for:

• Community-acquired pneumonia caused by susceptible strains of Streptococcus pneumoniae (including multi-drug resistant strains), Haemophilus influenzae, Moraxella catarrhalis, methicillin-susceptible Staphylococcus aureus, Klebsiella pneumoniae, Mycoplasma pneumoniae, or Chlamydophila pneumoniae 1

• Acute bacterial sinusitis caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis (reserved for patients with no alternative treatment options) 1

• Acute bacterial exacerbation of chronic bronchitis caused by susceptible isolates of Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, methicillin-susceptible Staphylococcus aureus, or Moraxella catarrhalis (reserved for patients with no alternative treatment options) 1

• Uncomplicated skin and skin structure infections caused by methicillin-susceptible Staphylococcus aureus or Streptococcus pyogenes 1

• Complicated skin and skin structure infections caused by methicillin-susceptible Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, or Enterobacter cloacae 1

• Complicated intra-abdominal infections including polymicrobial infections such as abscess caused by Escherichia coli, Bacteroides fragilis, Streptococcus anginosus, Streptococcus constellatus, Enterococcus faecalis, Proteus mirabilis, Clostridium perfringens, Bacteroides thetaiotaomicron, or Peptostreptococcus species 1

• Plague, including pneumonic and septicemic plague, due to Yersinia pestis 1

Antimicrobial Spectrum

Moxifloxacin has a broad spectrum of activity against:

• Gram-positive organisms, including penicillin- and macrolide-resistant Streptococcus pneumoniae 2, 3
• Gram-negative organisms 2
• Atypical respiratory pathogens 2
• Anaerobes 2

Efficacy in Clinical Practice

Clinical trials have demonstrated:

• Clinical success rates of 88-97% across approved indications 4
• Bacteriologic eradication rates of 90-97% 4
• Effectiveness in community practice settings with 92.9% overall clinical cure or improvement rates for respiratory tract infections 5

Regional Considerations for Intra-abdominal Infections

For complicated intra-abdominal infections:

• In Taiwan and regions with low fluoroquinolone resistance (<20%) and low ESBL-producing Enterobacteriaceae (<10%), moxifloxacin is considered an appropriate first-line therapy 6

• Not recommended as first-line therapy in countries with high fluoroquinolone resistance rates (>20%) among E. coli isolates, such as China, India, Thailand, and Vietnam 6

Safety Profile

• Most common adverse events are gastrointestinal (nausea 5.3%, diarrhea 2.2%) and dizziness (2.0%) 5

• Safety profile is comparable to standard therapies when used at recommended dosages and when contraindications are observed 7

• QT interval prolongation is a known effect (mean increase of 6 ± 26 milliseconds) requiring caution in patients with proarrhythmic conditions 4

Dosing Considerations

• Standard oral dosage is 400 mg once daily 4
• Available in both oral and intravenous formulations 2
• No dosage adjustment needed for patients with renal dysfunction or mild to moderate hepatic dysfunction 4

Clinical Pearls and Caveats

• Moxifloxacin should be reserved for acute bacterial sinusitis and acute bacterial exacerbation of chronic bronchitis in patients who have no alternative treatment options due to potential serious adverse reactions 1

• For intra-abdominal infections, local resistance patterns should guide therapy choice, with moxifloxacin being appropriate only in regions with low fluoroquinolone resistance 6

• Moxifloxacin has good tissue penetration and achieves high concentrations in clinically relevant tissues and fluids 2

• Once-daily administration offers convenience and may improve adherence 2, 3