Fluoroquinolone Antibiotic — Ophthalmic Pregnancy: Minimal systemic absorption — considered safe for topical use in pregnancy

Moxifloxacin Eye Drops 0.5%

Brand names: Moxeza, Vigamox

Adult dose

Dose: 1 drop three times daily (Vigamox) or twice daily (Moxi/Vigamox BD formulation)

Route: Topical (ophthalmic)

Frequency: Two to three times daily for 5–7 days

Max: 1 drop per dose; 3 doses/day

Preservative-free formulation available. Penetrates all ocular tissues well. Used for bacterial conjunctivitis, pre-operative prophylaxis, and post-operative prophylaxis after cataract surgery. Most active fluoroquinolone against Streptococcus pneumoniae and Staphylococcus aureus.

Paediatric dose

Route: Topical

Frequency: Three times daily

Max: Same as adult

Used in children for bacterial conjunctivitis; licensed from age 1 year in Vigamox

Dose adjustments

Renal

No systemic absorption at topical doses — no adjustment required

Hepatic

No adjustment required for topical use

Clinical pearls

Superior Gram-positive coverage compared to ciprofloxacin and ofloxacin eye drops — important for post-operative endophthalmitis prophylaxis where Staphylococci are the dominant pathogens
Bacterial conjunctivitis is largely self-limiting (7–10 days); topical antibiotics reduce duration by 1–2 days and reduce transmission — treatment most valuable for contact lens wearers, immunocompromised, and severe presentations
Post-cataract prophylaxis: intracameral cefuroxime has largely replaced topical antibiotics in many UK centres for endophthalmitis prevention (ESCRS trial) — however, pre- and post-operative topical moxifloxacin is still used as adjunct in many protocols
Viral conjunctivitis (adenoviral): the commonest form — topical antibiotics provide NO benefit; inappropriate prescribing is very common
Contact lens-associated bacterial keratitis (Pseudomonas): ciprofloxacin or moxifloxacin eye drops hourly initially — urgent ophthalmology referral required

Contraindications

Hypersensitivity to fluoroquinolones
Contact lens wear during treatment (remove; wait 15 minutes before reinserting)

Side effects

Ocular burning and stinging on instillation
Dry eye sensation
Hyperaemia
Taste disturbance (due to naso-lacrimal drainage — systemic absorption of drops)

Interactions

Minimal systemic absorption — no clinically significant drug interactions at topical doses

Monitoring

Resolution of symptoms at 5–7 days
If no response: consider viral aetiology, chlamydial infection (prolonged course), or corneal involvement — refer

Reference: BNFc; BNF 90; ESCRS Endophthalmitis Trial; NICE Guidelines (Conjunctivitis); SPC Vigamox. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways