Moxifloxacin-induced insomnia with psychotic episodes in a toddler: a case report

Moxifloxacin is a fourth-generation fluoroquinolone with a broad spectrum of antibacterial activity. It is commonly used for both local and systemic applications. Data on the safety profile of fluoroquinolones indicate the potential for serious adverse reactions including neurological and psychiatric disturbances. The current case describes the off-label use of moxifloxacin eye drops for nasal administration in a toddler which led to insomnia and symptoms of severe psychosis. Notably, these adverse events resolved completely shortly after discontinuation of treatment. This case highlights a rare and potentially debilitating adverse reaction and underscores the critical importance of clinical judgement when prescribing off-label medicines in the paediatric population.