What is the recommended dose for moxifloxacin (Moxifloxacin hydrochloride) in adults with normal renal function?

Moxifloxacin Dosage Recommendations

The standard recommended dose of moxifloxacin for adults with normal renal function is 400 mg once daily. 1, 2

Standard Dosing for Adults

• Moxifloxacin 400 mg once daily is the recommended dose for all approved indications in adults with normal renal function 1, 2
• The medication should be administered as a single daily dose, either orally or intravenously depending on the clinical situation 1
• No dosage adjustment is required in patients with renal impairment, including those requiring hemodialysis or continuous ambulatory peritoneal dialysis 1
• No dosage adjustment is necessary for patients with mild, moderate, or severe hepatic insufficiency (Child-Pugh Classes A, B, or C) 1

Indication-Specific Dosing Duration

• Community Acquired Pneumonia: 400 mg once daily for 7-14 days 1
• Uncomplicated Skin and Skin Structure Infections: 400 mg once daily for 7 days 1
• Complicated Skin and Skin Structure Infections: 400 mg once daily for 7-21 days 1
• Complicated Intra-Abdominal Infections: 400 mg once daily for 5-14 days 1
• Plague: 400 mg once daily for 10-14 days 2, 1
• Acute Bacterial Sinusitis: 400 mg once daily for 10 days 1
• Acute Bacterial Exacerbation of Chronic Bronchitis: 400 mg once daily for 5 days 1

Special Considerations

• For tuberculosis treatment, moxifloxacin is used at the same standard dose of 400 mg once daily 2
• When used in a 4-month rifapentine-moxifloxacin regimen for tuberculosis, the dose remains 400 mg daily for patients weighing ≥40 kg 2
• Moxifloxacin should be administered with caution in patients with known QT prolongation or those taking medications that can prolong the QT interval 1, 3
• Absorption may be reduced when co-administered with multivalent cation-containing products (antacids, sucralfate, multivitamins) - take moxifloxacin at least 4 hours before or 8 hours after these products 1

Pharmacokinetic Considerations

• Moxifloxacin has an absolute bioavailability of approximately 90% after oral administration 3
• The mean elimination half-life is approximately 12 hours, allowing for once-daily dosing 3
• Approximately 45% of an oral or intravenous dose is excreted as unchanged drug (~20% in urine and ~25% in feces) 1
• Unlike some other fluoroquinolones, moxifloxacin does not require dose adjustment in renal impairment due to its dual elimination pathway 1, 4

Safety Considerations

• Moxifloxacin prolongs the QT interval by a mean of 6 milliseconds, requiring caution in patients with proarrhythmic conditions 3
• The most common adverse effects are gastrointestinal disturbances (nausea, diarrhea) which are generally mild to moderate in severity 5, 3
• Moxifloxacin has a lower propensity for phototoxic reactions compared to some other fluoroquinolones 6, 7
• Serious adverse reactions including tendinitis, tendon rupture, peripheral neuropathy, and central nervous system effects have been reported with fluoroquinolones including moxifloxacin 1

The evidence consistently supports the 400 mg once-daily dosing of moxifloxacin across all approved indications for adults with normal renal function, with no need for dose adjustment in renal or hepatic impairment.