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Moxifloxacin is an 8-methoxyquinolone with enhanced potency against important Gram-positive pathogens, notably Streptococcus pneumoniae (penicillin-resistant and penicillin-susceptible strains), and class activity against Gram-negative bacteria. Its activity is not affected by beta-lactamases.

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Moxifloxacin blocks the rapid-component delayed-rectifier potassium channel in the heart, and thus prolongs the QTC interval by 6 minutes after oral administration and 12 minutes after intravenous administration. Moxifloxacin carries a greater risk of QT interval prolongation than ciprofloxacin, levofloxacin, and ofloxacin, and although the risk of moxifloxacin-induced tor-sade de pointes is expected to be minimal when the drug is given in the recommended dosage (400 mg/day), moxifloxacin should be used with caution in patients with prodysrhythmic conditions and avoided in patients taking antidysrhythmic drugs, such as quinidine, procainamide, amiodarone, and sotalol.

Specific Anti-Infective Agents

Clinicians should be familiar with the general classes of antibiotics, their mechanisms of action, and their major toxicities. The differences between the specific antibiotics in each class can be subtle, often requiring the expertise of an infectious disease specialist to design the optimal anti-infective regimen. The general internist or physician-in-training should not attempt to memorize all the facts outlined here, but rather should read the pages that follow as an overview of anti-infectives. The chemistry, mechanisms of action, major toxicities, spectrum of activity, treatment indications, pharmacokinetics, dosing regimens, and cost are reviewed.

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Moxifloxacin is used orally or IV for the treatment of respiratory tract infections (acute sinusitis, acute exacerbations of chronic bronchitis, community-acquired pneumonia) and uncomplicated skin and skin structure infections caused by susceptible bacteria. Moxifloxacin also is used as an alternative agent for the treatment of active tuberculosis.

Community-Acquired Pneumonia: Current Therapies

Many highly effective agents are available for the treatment of bacterial community-acquired pneumonia (community-acquired pneumonia) and other community-acquire respiratory tract infections (RTIs). Currently marketed antibiotics for community-acquired pneumonia demonstrate similar efficacy rates in clinical trials, and these agents have generally achieved clinical symptom resolution in 85-95% of trial participants.

Gemifloxacin

Gemifloxacin, as a member of the fluoroquinolone class, acts by inhibiting bacterial topoisomerase IV and DNA gyrase. These enzymes are required for DNA replication, transcription, repair, and recombination.

Acute Exacerbations of Chronic Bronchitis: Current therapies

TABLE: Pharmacological Management of Underlying Disease During an Acute Exacerbation of Chronic Bronchitis summarizes the general pharmacological agents and classes used to manage acute exacerbations of chronic bronchitis. The primary therapies used in acute exacerbations of chronic bronchitis treat the causative infection (antibiotics), relieve symptoms (bronchodilators), and treat the underlying inflammation (corticosteroids). TABLE: Current Therapies Used for Acute Exacerbations of Chronic Bronchitis summarizes the leading antibiotic therapies used to treat the infection.