OCTOBER                                                                                 2003

Multivitamin Injection Changes

The pharmacy will start using Infuvite^® Multiple Vitamins for Injection.  This product is formulated to meet the new FDA guidelines for daily maintenance supplementation for adults and children 11 years of age and up receiving parenteral nutrition.  The table below illustrates the changes in bold print.  Specifically, the amount of vitamin B₁ (thiamine), B₆ (pyridoxine), C (ascorbic acid), and folic acid were increased; the salt of vitamin D was changed; and most fundamentally important, VITAMIN K WAS ADDED. 

Formulary Addition

MOXIFLOXACIN HYDROCHLORIDE (VigamoxÒ)

0.5% (3 ml bottle) Ophthalmic Solution

VigamoxÒ is an ophthalmic fluoroquinolone antibiotic that is indicated for the treatment of bacterial conjunctivitis caused by susceptible strains of the following organisms. 

Aerobic Gram-positive                                 Aerobic Gram-negative microorganisms:

microorganisms:                                          Acinetobacter lwoffii^*

Corynebacterium species^*                                                  Haemophilus influenzae

Micrococcus luteus^*                                                                  Haemophilus parainfluenzae^*                      

Staphylococcus aureus

Staphylococcus epidermis                              Other microorganisms:

Staphylococcus haemolyticus                        Chlamydia trachomatis

Staphylococcus hominis

Staphylococcus warneri^*

Streptococcus pneumoniae

Streptococcus viridans group

^*Efficacy for this organism was studied in fewer than 10 infections.

All references to moxifloxacin shall refer to the ophthalmic formulation, unless otherwise indicated. The antibacterial action of moxifloxacin results from inhibition of topoisomerase II and topoisomerase IV.  Fluoroquinolone actions are unique to the actions of other antimicrobial classes, which may allow for activity against pathogens proved to be resistant to other antimicrobials.  Cross-resistance has been observed with systemic moxifloxacin and some other quinolones. 

Moxifloxacin is contraindicated in patients with a history of hypersensitivity to moxifloxacin, to other quinolones, or to any of the components in this medication.  Moxifloxacin should not be used for injection.  It should not be injected subconjunctivally, nor should it be introduced directly into the anterior chamber of the eye.  In patients receiving systemically administered quinolones, serious and occasionally fatal hypersensitivity reactions have been reported, some following the first dose.  Prolonged use of moxifloxacinmay result in overgrowth of non-susceptible organisms, including fungi.

Moxifloxacin is listed in pregnancy category C.  Since there are no adequate and well-controlled studies in pregnant women, it should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus.

The most frequently reported ocular adverse events were conjunctivitis, decreased visual acuity, dry eye, keratitis, ocular discomfort, ocular hyperemia, ocular pain, ocular pruritis, subconjunctival hemorrhage, and tearing.  These events occurred in approximately 1-6% of patients.  Nonocular adverse events reported at a rate of 1-4% were fever, increased cough, infection, otitis media, pharyngitis, rash, and rhinitis.

DRUG AND FOOD INTERACTIONS

The manufacturer’s prescribing information lists no food/drug interactions.

DOSAGE AND ADMINISTRATION

The recommended dose of moxifloxacin is one drop in affected eye three times a day for seven days.