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• Indications and Usage

  Moxifloxacin Hydrochloride is a fluoroquinolone antibiotic developed by Bayer Pharmaceuticals (Germany.) It can be used to treat community-acquired pneumonia caused by Staphylococcus aureus, baccilus, pneumococcus, mucositis Moraxella, and Klebsiella pneumoniae, acute chronic bronchitis attacks, and acute sinusitis. For the treatment of adult bacterial lung infections, paranasal sinus, skin, and abdominal cavity. Also used to treat community-acquired pneumonia, chronic bronchitis, urogenital infection, and acute sinusitis. ;

• Mechanisms of Action

  Its active mechanisms and in vitro antibacterial spectrums are similar to those of other fluoroquinolones, but its profile towards gram-positive and anaerobic bacteria is similar to that of trovafloxacin, better than some older drugs. Compared with other fluoroquinolones, few gram-positive bacteria are resistant to Moxifloxacin Hydrochloride, or the spread of resistance is very slow. Gram-negative and enterococci strains with cross resistance to other fluoroquinolones have been found. It is effective at least against Staphylococcus aureus strains grlA, grlB, gyrA and gyrBcan, and 0.5-2 mg/L can inhibit Ciprofloxacin resistant Staphylococcus aureus, from large MIC to small Ciprofloxacin, Ofloxacin, Levofloxacin, Sparfloxacin, and Moxifloxacin. ;

• Pharmacokinetics

  After 45 healthy volunteers were orally administered single doses of 50-800 mg, their peak plasma concentration and area under the curve (AUC) increased linearly with dosage. Recommended oral dose is 400 mg, average Cmax is 2.5mg/L, peak time (tmax) is 1.5 hours, and AUC is 26.9 mg•h/L. For healthy volunteers who took 400 mg per day orally for 10 days, Cmax was 4.52 mg/L, 1.59 accumulated over 10 days. Oral bioavailability is 89%, apparent distribution volume 3.55 L/kg, plasma protein binding rate 48%. For 400 mg intravenously, Cmaxis 3.62 mg/L. AUC 34.6 mg•h/L. 24 hours after 13 healthy volunteers were given a single oral dose or intravenous injection of 400 mg, skin blister fluid concentration was twice that of serum, suggesting easier penetration of interstitial tissue. One hour after 18 patients ingested a single oral dose of 400 mg before undergoing bronchoscopy, bronchial epithelial cell fluid and bronchial biopsy tissue concentrations were 24.4 and 5.5 mg / L respectively, greater than the plasma concentration after 12 hours. An extremely high concentration (113.6 mg/L) was reached in macrophages. After 34 patients with chronic sinusitis received 5 oral doses of 400 mg, concentration in maxillary sinus mucosa exceeded blood plasma concentration. Three hours after the last dose, blood concentration peaked at 7.47 mg/kg; after 36 hours it was 1.25 mg/kg，suggesting a post-dosage effect.
  After healthy volunteers received an oral dose of 400 mg, total clearance rate and renal clearance rates were 14.9 and 3.03 L per hour respectively. The drug apparently does not undergo P450 metabolism. Metabolized in vitro into N-sulfate and acyl glucuronide, metabolites inactive. After healthy volunteers took 400 mg/d orally, the average elimination half-life (t1/2β) during the first day was 9.3 hours, 11.95 hours over 10 days. Another study showed that the average t1/2β is about 10-16 hours. After a single oral dose or intravenous infusion of 400 mg, the urine reabsorption rates were 19%-20% and 22% respectively. ;

• Adverse Effects

  The adverse effects of this product are mostly mild and transient, and 3.8% of patients discontinued treatment as a result of adverse effects. The most common effects were nausea (7.2%) and diarrhea (5.7%). The incidence of dizziness was 2.8%. Healthy volunteers experienced no changes in vital signs, hematology, blood biochemistry, and ECG. Studies show that it is different from lomefloxacin and did not show any phototoxicity. ;

• Warnings and Precautions

  Similar to other fluoroquinones, bioavailability of 400 mg of Moxifloxacin Hydrochloride declined significantly after combination with antacids. AUC and cmax decreased 45% and 40% compared with when used alone, but Moxifloxacin Hydrochloride absorption was not significantly affected when taken 2 hours before or 4 hours after taking antacids. When taken with iron, absorption decreased significantly, with AUC and cmax was 39% and 59% lower, respectively. No interaction with theophylline, probenecid, ranitidine, or warfarine. ;

• Adverse reactions

  Side effects of this product are mostly mild and transient , 3.8% of the patient discontinued treatment due to adverse events . The most common adverse reactions are nausea (7.2%) and diarrhea (5.7%). Dizziness is 2.8%. In healthy volunteers, no changes in vital signs, hematology, blood biochemistry and electrocardiogram.
  Studies have shown that the product is different from lomefloxacin , no drug-induced light toxicity. ;

• Precautions

  Similar to other fluoroquinolones , the product (400mg) in combination with antacids, bioavailability will fall significantly, AUC and cmax fall down 45% and 40% respectively when compared with alone, but using the moxifloxacin hydrochloride 2h before taking antacids or using antacids 4h after using this service, the absorption of the drug has no effect. If the product in combination with iron ,absorption rate decreases, AUC and cmax are reduced by 39% and 59%. The product has no interaction with theophylline, probenecid, ranitidine and warfarin . ;

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