Antimicrobials

Active against:

• Streptococcus (Streptococcus pneumoniae, Beta-hemolytic streptococci)
• Most aerobic Gram negatives including Haemophilus influenza, Klebsiella pneumoniae, Moraxella catarrhalis
• Atypical bacteria (Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumophilia)
• Select anaerobes, including Bacteroides fragilis (*note: ~30% resistance)

Not active against:

• Methicillin-resistant S. aureus (MRSA)
• Vancomycin-Resistant Enterococcus (VRE)
• Pseudomonas aeruginosa

Appropriate Uses:

• Community-acquired pneumonia, in the setting of severe penicillin allergy (levofloxacin is the preferred respiratory fluoroquinolone for community-acquired pneumonia at SHSC)
• Complicated intra-abdominal infections including polymicrobial infections and abscesses*
• Skin and soft tissue infections including diabetic foot infections
• *Note: combination therapy with metronidazole recommended in severe infections due to increasing resistance of B. fragilis to moxifloxacin (50% are not susceptible)

Inappropriate Uses:

• Treatment of late onset hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP)**
• Treatment of UTI/urosepsis (achieves insufficient urinary concentrations)
• **Note: during levofloxacin shortage, may consider moxifloxacin for early HAP onset < 5 days in the setting of a severe penicillin allergy where Pseudomonas is not a suspected pathogen

• Pregnancy: Limited human data; no evidence of significant risk for
• Breastfeeding: Limited human data; likely excreted through human breast milk. Effects of exposure unknown

• GI intolerance: abdominal pain, nausea, vomiting, diarrhea, dyspepsia
• CNS (<1%): headache, dizziness, malaise, seizures (rare, <0.1% incidence)
• Cardiac (<1%): QTc prolongation with risk for progression to Torsades de Pointes. Caution in patients with risk factors (concurrent QT prolonging medications, cardiac comorbidities, advanced age, etc)
• Hypersensitivity reactions
• Tendonopathy

• Usual: 400 mg PO/IV q24h
• No dose reduction required in renal impairment or dialysis

• Intermittent Infusion: Infuse over 60 minutes
• Please refer to IV drug monograph on pharmacy intranet page for additional administration information.