Underneath the RADAR

The National Prescribing Service (NPS) produces RADAR (Rational Assessment of Drugs And Research) to inform people about changes to the Pharmaceutical Benefits Scheme. Australian Prescriber will be publishing some of the information underlying important changes, but a wider range of topics will appear in RADAR. The RADAR location is www.npsradar.org.au

The quinolone antibiotic moxifloxacin has been listed on the Pharmaceutical Benefits Scheme (PBS), for the oral treatment of community-acquired pneumonia in adults and children over 12 years old who have immediate hypersensitivity to penicillin. An authority prescription will be required.

This new listing extends the number of patients who can be treated with moxifloxacin. The PBS already subsidises intravenous and oral moxifloxacin, but only for patients with severe community-acquired pneumonia who require admission to a high dependency unit or intensive care. The new listing means moxifloxacin can be prescribed in the community for patients who are hypersensitive to penicillin.

While moxifloxacin can now be used for less severe cases of pneumonia, it is not the drug of choice for most patients. The Therapeutic Guidelines: Antibiotic recommend that patients treated outside hospital should receive oral amoxycillin with either roxithromycin or doxycycline. In patients who are allergic to penicillin, but do not have immediate hypersensitivity, cefuroxime can be substituted for amoxycillin. Moxifloxacin is therefore reserved for patients with immediate hypersensitivity to penicillin. 1 These patients will have a history of anaphylaxis, urticaria, bronchospasm or angioedema developing within 60 minutes of taking penicillin. While quinolone antibiotics are currently effective in community-acquired pneumonia, bacterial resistance can develop quickly. It is therefore essential that moxifloxacin is only prescribed in the community when other antibiotics are unsuitable. In addition to a clear history of immediate hypersensitivity to penicillin, radiological confirmation of the pneumonia will be required before the drug can be supplied by the PBS.

Reference

1. Antibiotic Writing Group. Therapeutic Guidelines: Antibiotic. 12th ed. Melbourne: Therapeutic Guidelines Limited; 2003.