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INTRODUCTION

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moxifloxacin (mox-i-flox-a-sin)

Avelox

Classification

Therapeutic: anti-infectives

Pharmacologic: fluoroquinolones

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Indications
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Treatment of the following bacterial infections: Respiratory tract infections, including acute sinusitis, acute exacerbations of chronic bronchitis, and communityacquired pneumonia (CAP), Uncomplicated and complicated skin and skin structure infections.

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Action
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Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme. Therapeutic Effects: Death of susceptible bacteria. Spectrum: Active against gram-positive pathogens, including Staphylococcus aureus, Streptococcus pyogenes, S. pneumoniae (including multi–drug-resistant strains). Gram-negative spectrum notable for activity against Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae, H. parainfluenzae, Moraxella catarrhalis. Additional spectrum includes Chlamydophylia pneumoniae, Mycoplasma pneumoniae.

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Adverse Reactions/Side Effects
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CNS: agitation, anxiety, dizziness, headache, insomnia. CV: QTc prolongation, ARRHYTHMIAS. GI: PSEUDOMEMBRANOUS COLITIS, abdominal pain, abnormal liver function tests, diarrhea, dyspepsia, nausea, vomiting. Derm: photosensitivity. MS: tendinitis, tendon rupture. Misc: HYPERSENSITIVITY REACTIONS, INCLUDING ANAPHYLAXIS.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

  • Monitor signs of hypersensitivity reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, angioedema, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

  • Be alert for signs of hepatotoxicity, including anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician.

  • Assess any tendon pain. Tendinopathy and rupture can occur, especially in large, weight-bearing tendons (Achilles, patellar tendons). Risk of tendon damage is greater in patients >65 yrs old, transplant recipients (i.e., kidney, heart, lung), patients with preexisting tendon damage, and patients taking corticosteroids concurrently.

  • Monitor signs of peripheral neuropathy (numbness, tingling). Perform objective tests (nerve conduction, monofilaments) to document any neuropathic changes.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

  • Be alert for anxiety, agitation, or other alterations in mental status. Notify physician promptly if these symptoms develop.

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Interventions
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  • If tendon symptoms occur, notify the physician and protect the affected area to avoid tendon ruptures. Do not stretch or exercise the affected tendon, and provide crutches, walker, or other assistive devices if lower extremities are involved.

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