moxifloxacin
Sources réglementaires consultées
Indications approuvées
- Pneumonie communautaire, infections cutanées compliquées, maladie inflammatoire pelvienne et certaines infections respiratoires lorsque les autres options ne conviennent pas.
Contre-indications
Absolues
- Hypersensibilité à la moxifloxacine ou à d’autres quinolones ; grossesse, allaitement ou âge inférieur à 18 ans ; QT long congénital ou acquis, hypokaliémie non corrigée, bradycardie cliniquement pertinente, insuffisance cardiaque avec fraction d’éjection réduite, arythmie symptomatique ou traitement par d’autres médicaments allongeant le QT ; insuffisance hépatique Child-Pugh C ou transaminases >5 fois la limite supérieure.
Mises en garde cliniques
- Il peut provoquer une tendinite ou une rupture tendineuse, une neuropathie périphérique et des effets du système nerveux central invalidants ou potentiellement irréversibles ; arrêter immédiatement dès les premiers symptômes. — CIMA/AEMPS, ficha técnica 77662
- Il peut exacerber une myasthénie et provoquer une faiblesse respiratoire ; éviter chez les patients ayant cet antécédent. — CIMA/AEMPS, ficha técnica 77662
- Mise en garde majeure · Il a été associé à un anévrisme ou une dissection aortique ; éviter chez les patients à haut risque sauf absence d’alternative et orienter en urgence en cas de douleur thoracique, abdominale ou dorsale soudaine. — CIMA/AEMPS, ficha técnica 77662
- Mise en garde majeure · Il peut perturber la glycémie, y compris provoquer une hypoglycémie sévère ; surveiller la glycémie chez les personnes diabétiques et arrêter en cas d’anomalie importante. — CIMA/AEMPS, ficha técnica 77662
- Mise en garde majeure · Une diarrhée et une colite à Clostridioides difficile peuvent survenir pendant ou après le traitement ; évaluer toute diarrhée importante et arrêter si le diagnostic est confirmé. — CIMA/AEMPS, ficha técnica 77662
- Mise en garde majeure · Il prolonge le QT de manière dose-dépendante ; il est contre-indiqué en cas de QT long, de troubles électrolytiques non corrigés, de bradycardie cliniquement pertinente, d’insuffisance cardiaque avec fraction d’éjection réduite, d’arythmie symptomatique ou d’autres médicaments allongeant le QT. — CIMA/AEMPS, ficha técnica 77662
Interactions médicamenteuses
- SévèreAntiacides et suppléments contenant des cations multivalents
Mécanisme: L’aluminium, le magnésium, le calcium, le fer et le zinc forment des chélates et réduisent fortement l’absorption orale.
Recommandation: Espacer les prises selon l’intervalle propre au produit.
CIMA/AEMPS, ficha técnica 77662
- SévèreWarfarine et anticoagulants coumariniques
Mécanisme: Il peut augmenter l’effet anticoagulant et l’INR.
Recommandation: Surveiller l’INR et les signes de saignement pendant et après le traitement.
CIMA/AEMPS, ficha técnica 77662
- ModéréeMédicaments allongeant le QT
Mécanisme: L’allongement de la repolarisation peut être additif et provoquer des torsades de pointes.
Recommandation: Ne pas administrer avec les antiarythmiques de classe IA/III, les antipsychotiques, les tricycliques, certains antimicrobiens et les autres médicaments QT contre-indiqués.
CIMA/AEMPS, ficha técnica 77662
Effets indésirables
Communs (≥1%)
Nausées, diarrhée, céphalées et vertiges
Rares mais graves
Rupture tendineuse, neuropathie périphérique persistante, réaction neuropsychiatrique sévère, anaphylaxie et dissection aortique
Grossesse et allaitement
Elle est contre-indiquée pendant la grossesse et l’allaitement selon le produit CIMA.
Bibliographie récente (PubMed)
Age-related cataract, defined as progressive opacification or clouding of the eye's natural lens, is a leading cause of visual disability and blindness. Cataract surgery is one of the most commonly performed procedures in high-income countries. More than 3.5 million cataract operations are performed annually in the US. Older age is the primary risk factor for cataracts, with approximately two-thirds of the population older than 80 years affected. As the population ages, the number of people with cataracts in the US is expected to increase to 50 million by 2050. Additional risk factors for cataracts include a hereditary or genetic predisposition, certain medications (corticosteroids), ocular trauma, significant UV exposure or radiation therapy, and certain medical conditions such as uncontrolled diabetes, retinitis pigmentosa, Down syndrome, and congenital rubella. Painless, progressive blurring of vision and visual glare are common symptoms of cataracts. Cataracts are diagnosed during an eye examination by an ophthalmologist or optometrist. Surgery to remove the cataract and implant a permanent intraocular lens (IOL) is indicated if visual impairment impedes activities of daily living and is associated with lower rates of falls (>30%) and dementia (20%-30%). Most cataract operations are performed with topical anesthesia. Therefore, patients do not require preoperative general medical testing such as bloodwork or electrocardiogram, and do not need to discontinue anticoagulants for cataract surgery. Systemic α1-adrenergic antagonists for symptomatic benign prostatic hyperplasia, such as tamsulosin, increase the risk of surgical complications and some ophthalmologists temporarily discontinue the drug preoperatively. Intraocular antibiotics, such as moxifloxacin or cefuroxime, delivered intraoperatively have reduced the rates of sight-threatening postsurgical endophthalmitis from 0.07% to 0.02%. In addition to reversing and preventing progressive vision loss, cataract s
Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal (antiphospholipid) antibodies. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles, such as metronidazole, are effective treatments for gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral treatment options for gonorrhea and M genitalium. No cure is available for genital herpes. Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception. Approximately 1 in 5 adults in the US had an STI in 2018. Rates of gonorrhea, chlamydia, and syphilis in the US have increased, while rates of HSV-1 and HSV-2 have declined.
Background: On the basis of recent clinical trial data for the treatment of drug-susceptible and drug-resistant tuberculosis (TB), the American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America have updated clinical practice guidelines for TB treatment in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. Methods: A Joint Panel representing multiple interdisciplinary perspectives convened with American Thoracic Society methodologists to review evidence and make recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) and GRADE-ADOLOPMENT (adoption, adaptation, and, as needed, de novo development of recommendations) methodology. Results: New drug-susceptible TB recommendations include the use of a novel 4-month regimen for people with pulmonary TB and a shortened 4-month regimen for children with nonsevere TB. Drug-resistant TB recommendation updates include the use of novel regimens containing bedaquiline, pretomanid, and linezolid with or without moxifloxacin. Conclusions: All-oral, shorter treatment regimens for TB are now recommended for use in eligible individuals.
Legionellosis is the infection caused by bacteria of the genus Legionella, including a non-pneumonic influenza-like syndrome, and Legionnaires' disease is a more serious illness characterized by pneumonia. Legionellosis is becoming increasingly important as a public health problem throughout the world; although it is an underreported disease, studies have consistently documented a high incidence. In addition, health costs associated with the disease are high. Diagnosis of Legionnaires' disease is based mainly on the detection of Legionella pneumophila serogroup 1 antigen in urine. However, there have been advances in detection tests for patients with legionellosis. New methodologies show greater sensitivity and specificity, detect more species and serogroups of Legionella spp., and have the potential for use in epidemiological studies. Testing for Legionella spp. is recommended at hospital admission for severe community-acquired pneumonia, and antibiotics directed against Legionella spp. should be included early as empirical therapy. Inadequate or delayed antibiotic treatment in Legionella pneumonia has been associated with a worse prognosis. Either a fluoroquinolone (levofloxacin or moxifloxacin) or a macrolide (azithromycin preferred) is the recommended first-line therapy for Legionnaires' disease; however, little information is available regarding adverse events or complications, or about the duration of antibiotic therapy and its association with clinical outcomes. Most published studies evaluating antibiotic treatment for Legionnaires' disease are observational and consequently susceptible to bias and confounding. Well-designed studies are needed to assess the usefulness of diagnostic tests regarding clinical outcomes, as well as randomized trials comparing fluoroquinolones and macrolides or combination therapy that evaluate outcomes and adverse events.
For decades, poor treatment options and low-quality evidence plagued care for patients with rifampin-resistant tuberculosis. The advent of new drugs to treat tuberculosis and enhanced funding now permit randomized, controlled trials of shortened-duration, all-oral treatments for rifampin-resistant tuberculosis. We conducted a phase 3, multinational, open-label, randomized, controlled noninferiority trial to compare standard therapy for treatment of fluoroquinolone-susceptible, rifampin-resistant tuberculosis with five 9-month oral regimens that included various combinations of bedaquiline (B), delamanid (D), linezolid (L), levofloxacin (Lfx) or moxifloxacin (M), clofazimine (C), and pyrazinamide (Z). Participants were randomly assigned (with the use of Bayesian response-adaptive randomization) to receive one of five combinations or standard therapy. The primary end point was a favorable outcome at week 73, defined by two negative sputum culture results or favorable bacteriologic, clinical, and radiologic evolution. The noninferiority margin was -12 percentage points. Among the 754 participants who underwent randomization, 699 were included in the modified intention-to-treat analysis, and 562 in the per-protocol analysis. In the modified intention-to-treat analysis, 80.7% of the patients in the standard-therapy group had favorable outcomes. The risk difference between standard therapy and each of the four new regimens that were found to be noninferior in the modified intention-to-treat population was as follows: BCLLfxZ, 9.8 percentage points (95% confidence interval [CI], 0.9 to 18.7); BLMZ, 8.3 percentage points (95% CI, -0.8 to 17.4); BDLLfxZ, 4.6 percentage points (95% CI, -4.9 to 14.1); and DCMZ, 2.5 percentage points (95% CI, -7.5 to 12.5). Differences were similar in the per-protocol population, with the exception of DCMZ, which was not noninferior in that population. The proportion of participants with grade 3 or higher adverse events was similar across the r