Usage
Cefixime + Moxifloxacin is a combination antibiotic used to treat various bacterial infections, including:
- Respiratory tract infections (e.g., bronchitis, pneumonia)
- Urinary tract infections
- Skin and soft tissue infections
- Sexually transmitted infections (e.g., gonorrhea, pelvic inflammatory disease)
- Typhoid fever
- Sinusitis
- Otitis media (ear infection)
- Tonsillitis
Pharmacological Classification: Antibacterial (Combination of a cephalosporin and a fluoroquinolone)
Mechanism of Action: Cefixime inhibits bacterial cell wall synthesis by disrupting peptidoglycan cross-linking. Moxifloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for DNA replication and repair. The combination provides broad-spectrum coverage.
Alternate Names
No widely recognized alternate names exist for the combination itself. However, the individual components are known by their generic names (cefixime and moxifloxacin) and various brand names (e.g., Monarquin Plus).
How It Works
Pharmacodynamics: Cefixime disrupts bacterial cell wall integrity, leading to cell death. Moxifloxacin interferes with bacterial DNA replication and repair, ultimately causing bacterial death.
Pharmacokinetics:
- Absorption: Both drugs are absorbed orally. Food may slightly delay cefixime absorption but doesn’t significantly affect moxifloxacin.
- Metabolism: Cefixime is minimally metabolized. Moxifloxacin undergoes some glucuronidation.
- Elimination: Cefixime is primarily excreted renally. Moxifloxacin is excreted in both urine and feces.
Mode of Action: Cefixime targets penicillin-binding proteins (PBPs) involved in cell wall synthesis. Moxifloxacin targets bacterial DNA gyrase and topoisomerase IV, inhibiting DNA replication and repair.
Elimination Pathways: Cefixime is primarily excreted unchanged in the urine. Moxifloxacin is eliminated through both renal and hepatic pathways, with glucuronidation being a minor metabolic pathway.
Dosage
Standard Dosage
Adults: 400 mg of cefixime and 400 mg of moxifloxacin, both administered once daily.
Children: Use with caution in children below 12 years of age. Dosage is weight-based and should be determined by a physician.
Special Cases:
- Elderly Patients: Generally, no dosage adjustment is needed unless renal function is impaired.
- Patients with Renal Impairment: Cefixime dosage should be adjusted based on creatinine clearance. Moxifloxacin dosage adjustment may also be necessary.
- Patients with Hepatic Dysfunction: Cefixime dosage adjustment is generally not required. Moxifloxacin should be used with caution, and dosage adjustments may be needed.
- Patients with Comorbid Conditions: Caution is advised in patients with diabetes, epilepsy, heart disease, and electrolyte imbalances.
Clinical Use Cases
Dosages in specific clinical settings are similar to standard dosages, with the duration of treatment determined by the infection’s severity and clinical response.
Dosage Adjustments
Adjustments are based on renal and hepatic function, as described above.
Side Effects
Common Side Effects:
- Headache
- Dizziness
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Flatulence
Rare but Serious Side Effects:
- QT interval prolongation
- Seizures
- Tendonitis/tendon rupture
- Clostridium difficile infection
- Severe allergic reactions
Long-Term Effects:
- Peripheral neuropathy (rare)
Adverse Drug Reactions (ADR)
- Anaphylaxis
- Stevens-Johnson Syndrome
- Toxic epidermal necrolysis
Contraindications
- Hypersensitivity to cefixime, moxifloxacin, or other quinolones/cephalosporins.
- History of QT prolongation or cardiac arrhythmias.
- Pregnancy and breastfeeding (generally contraindicated).
- Children under 12 years of age (use with caution).
- Myasthenia gravis.
Drug Interactions
- Antacids, sucralfate, metal cations (reduce absorption).
- Anticoagulants (warfarin).
- Antiarrhythmics (amiodarone).
- Anticonvulsants (carbamazepine).
- CYP450 substrates.
Pregnancy and Breastfeeding
Generally contraindicated due to potential risks to the fetus and newborn.
Drug Profile Summary
(See information above in each respective section.)
Popular Combinations
No specific popular combinations exist for cefixime + moxifloxacin. However, each drug may be used in combination with other antibiotics depending on the infection.
Precautions
(See information above in “Special Cases”, “Contraindications” and “Drug Interactions”.)
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefixime + Moxifloxacin?
A: 400 mg of each drug once daily for adults. Pediatric doses should be weight-based and determined by a physician.
Q2: What are the common side effects?
A: Common side effects include headache, dizziness, nausea, vomiting, diarrhea, abdominal pain, and flatulence.
Q3: What are the serious side effects?
A: Serious side effects include QT interval prolongation, seizures, tendon rupture, Clostridium difficile infection, and severe allergic reactions.
Q4: Can this combination be used in pregnant or breastfeeding women?
A: Generally contraindicated due to potential fetal harm and excretion in breast milk.
Q5: What are the contraindications to using this medication?
A: Contraindications include hypersensitivity, QT prolongation history, pregnancy, breastfeeding, and myasthenia gravis.
Q6: What drugs interact with this combination?
A: Interacting drugs include antacids, sucralfate, metal ions, warfarin, amiodarone, and carbamazepine.
Q7: How does this combination work against bacteria?
A: Cefixime inhibits cell wall synthesis, and moxifloxacin inhibits DNA replication and repair, leading to bacterial death.
Q8: What infections is this combination used to treat?
A: It is used for respiratory, urinary tract, skin, some sexually transmitted infections, typhoid fever, sinusitis and more.
Q9: Can this combination be used in children?
A: It should be used with caution in children under 12, with weight-based dosing.
Q10: Should the dose be adjusted for patients with kidney or liver problems?
A: Yes, dosage adjustments may be necessary based on renal and hepatic function.
