Gatifloxacin (Tequin®) and moxifloxacin (Avelox®) Therapeutics Letter

Canadian Family Physician

K. Bassett B. Mintzes V. Musini T.L. Perry Jr M. Wong J.M. Wright

Approved indications for both. Acute sinusitis, community-acquired pneumonia (CAP), and acute exacerbation of chronic bronchitis (AECB).26,27 Additional indications for gatifloxacin are uncomplicated and complicated urinary tract infections (UTI), pyelonephritis, and uncomplicated gonorrhea.26

Mechanism of action. Similar to other fluoroquinolone antibiotics.

Pharmacokinetics. Both are well absorbed with half-lives of 12 hours. Gatifloxacin is eliminated by the kidneys; moxifloxacin is metabolized by the liver.26,27

Evidence of effectiveness. Gatifloxacin has been compared with other antibiotics in nine double-blind RCTs. Eight of these trials showed clinical efficacy ranging from 88% to 98%, which was similar to levofloxacin, ofloxacin, clarithromycin, and erythromycin for treatment of acute sinusitis, CAP, AECB, UTI, and gonorrhea.28-35 In one trial, gatifloxacin was significantly more effective than cefuroxime axetil (ARR 12%) for treatment of AECB.36 Moxifloxacin has been compared with other antibiotics in 10 double-blind RCTs. These trials showed clinical efficacy for treatment of acute sinusitis, CAP, and AECB ranging from 88% to 97%, which was similar to levofloxacin, cefuroxime axetil, clarithromycin, amoxicillin, and azithromycin (87% to 95%).37-48

Adverse effects. Gatifloxacin and moxifloxacin have tolerability profiles similar to other fluoroquinolones. Adverse effects include gastrointestinal upset (nausea, diarrhea, vomiting, and abdominal pain), headache, and dizziness. Adverse effects reported since marketing are ventricular tachycardia, renal failure, peripheral neuropathy, myositis, and tendonitis.26,27

Dose and cost. Gatifloxacin (Tequin®), 400 mg once daily ($5.36/d); moxifloxacin (Avelox®), 400 mg once daily ($5.36/d); ciprofloxacin (Cipro®), 250 to 500 mg twice daily ($4.76 to 5.40/d); ofloxacin (Floxin®, generic), 400 mg twice daily ($3.81/d); and levofloxacin (Levaquin®), 250 to 500 mg daily ($4.85 to 5.52/d).

Conclusion. Gatifloxacin and moxifloxacin have no proven clinical advantages over other fluoroquinolones, macrolides, or amoxicillin. Based on cost, they are not first-choice drugs for their approved indications.