Drug Shortages - IV Moxifloxacin, IV Levofloxacin

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Drug Shortages - IV Moxifloxacin, IV Levofloxacin

28-Aug-2017

Moxifloxacin IV is in shortage supply. Bayer indicates drug supplies will be low until March 2018.

Moxifloxacin IV is in a drug shortage position and has been placed on allocation (a very limited amount is available). Bayer indicates they do not expect a usual supply until March 2018.

Levofloxacin IV is also on allocation. There appears to be some minimal ability to obtain for emergency situations from Pfizer; duration of this shortage is not yet clear.  

In consultation with RQHR Infectious Disease Specialists and RQHR Medical Microbiologists, the following options are suggested: 

Infection1st Options (Oral)IV Alternatives
CAP
  • PO Cefprozil or Cefuroxime (2nd Gen Ceph),
    PLUS PO Clarithromycin or Azithromycin
  • PO Levofloxacin or Moxifloxacin
  • IV Cefuroxime + IV Azithromycin If NPO
  • IV Ceftriaxone + IV Azithromycin if SEVERE
 
HAP/VAP
  • PO/NG Levofloxacin or 
    Moxifloxacin if possible
  • IV Ceftriaxone
  • IV Pip/tazo if suspect Pseudomonas
IAI
  • PO Moxifloxacin
  • PO Cefprozil or Cefuroxime,
    PLUS PO Metronidazole
  • IV Ceftriaxone + IV Metronidazole
  • IV Ertapenem
 

CAP = Community-Acquired Pneumonia, HAP=Hospital-Acquired Pneumonia,VAP =Ventilator-Associated Pneumonia,IAI=Intra-abdominal Infection

NOTES:

* Oral fluoroquinolones have ≈100% bioavailability providing blood and tissue levels similar to the IV route. If the patient is taking oral feeds, or oral medications, the use of oral antibiotics is the initial suggested alternative. 

Patients with documented severe beta-lactam allergy (previous anaphylaxis, shortness of breath, or facial/throat swelling):  Contact a RQHR pharmacist for possible alternatives for the specific infection involved. If additional clinical support is required or a complex infection, consult ID, or contact a medical microbiologist.

 

Submitted by: Dr. Bill Semchuk, Manager, Clinical Pharmacy Services