Avelox

Avelox contains moxifloxacin, a fluoroquinolone that kills bacteria by blocking the enzymes they need to copy their DNA. Because this class can cause long-lasting, disabling and sometimes irreversible side effects, the UK SmPC says it must only be used when the antibiotics normally recommended for an infection are inappropriate: for instance, when there is resistance, a contraindication, intolerance or a failed first course. Within that limit it is licensed for adults with acute bacterial sinusitis, flare-ups of chronic obstructive pulmonary disease including bronchitis, community-acquired pneumonia that is not severe, and mild to moderate pelvic inflammatory disease, where it is given together with another antibiotic. It can also complete a course started with intravenous moxifloxacin.

Only one strength exists, a 400 mg film-coated tablet, which is listed here in packs of 10, 20 or 30. A single course normally needs between 5 and 14 tablets, depending on the infection. The tablets supplied are imported, so packaging may differ from the UK pack. Keep any unused tablets only if told to; a fluoroquinolone should never be saved for a later, self-diagnosed infection.

The adult dose is one 400 mg tablet once daily, swallowed whole with plenty of liquid, with or without food. The SmPC gives these course lengths: 5 to 10 days for a COPD flare-up, 10 days for pneumonia, 7 days for sinusitis and 14 days for pelvic inflammatory disease. Neither the dose nor the duration should be exceeded. No change is needed for older people or for any degree of kidney impairment, including dialysis. Iron, zinc, antacids containing magnesium or aluminium, and sucralfate reduce absorption, so about six hours should separate them from the tablet.

Avelox 400 mg film-coated tablets are licensed in the UK, with Bayer plc as the marketing authorisation holder, and generic moxifloxacin tablets are also available. As an antibiotic, it is classed as a prescription-only medicine (POM). The MHRA has repeatedly reminded prescribers to keep fluoroquinolones for situations where other options are not suitable, and the prescriber decides whether this antibiotic is justified.

Moxifloxacin is contraindicated under 18 years, in pregnancy and breastfeeding, after tendon problems linked to a previous quinolone, and in severe liver impairment. It lengthens the QT interval, so it must not be used with congenital or acquired QT prolongation, low potassium that has not been corrected, a markedly slow heart rate, heart failure with reduced ejection fraction or a history of symptomatic arrhythmia, nor combined with other medicines that prolong QT, such as certain antiarrhythmics, antipsychotics and antidepressants. Older people, those on corticosteroids and anyone with risk factors for aortic aneurysm or heart valve disease need particular caution.

Nausea and diarrhoea are the most frequent effects; headache, dizziness, stomach pain, vomiting, raised liver enzymes and thrush are also common. Treatment should stop at the first sign of tendon pain or swelling, especially around the heel. Numbness, tingling or burning in the hands or feet, palpitations or fainting, sudden severe chest, back or abdominal pain, severe or bloody diarrhoea, mood changes or a blistering rash all need urgent medical advice, and severe symptoms warrant A&E. Dizziness or brief visual disturbance can affect driving, so check how Avelox affects you first.