Moxifloxacin Pharmacokinetics and Pleural Fluid Penetration in Patients with Pleural Effusion

Abstract

The aim of this study was to evaluate the pharmacokinetics and penetration of moxifloxacin (MXF) in patients with various types of pleural effusion. Twelve patients with empyema/parapneumonic effusion (PPE) and 12 patients with malignant pleural effusion were enrolled in the study. A single-dose pharmacokinetic study was performed after intravenous administration of 400 mg MXF. Serial plasma (PL) and pleural fluid (PF) samples were collected during a 24-h time interval after drug administration. The MXF concentration in PL and PF was determined by high-performance liquid chromatography, and main pharmacokinetic parameters were estimated. Penetration of MXF in PF was determined by the ratio of the area under the concentration-time curve from time zero to 24 h (AUC 24 ) in PF (AUC 24PF ) to the AUC 24 in PL. No statistically significant differences in the pharmacokinetics in PL were observed between the two groups, despite the large interindividual variability in the volume of distribution, clearance, and elimination half-life. The maximum concentration in PF (Cmax PF ) in patients with empyema/PPE was 2.23 ؎ 1.31 mg/liter, and it was detected 7.50 ؎ 2.39 h after the initiation of the infusion. In patients with malignant effusion, Cmax PF was 2.96 ؎ 1.45 mg/liter, but it was observed significantly earlier, at 3.58 ؎ 1.38 h (P < 0.001). Both groups revealed similar values of AUC 24PF (31.83 ؎ 23.52 versus 32.81 ؎ 12.66 mg · h/liter). Penetration of MXF into PF was similarly good in both patient groups (1.11 ؎ 0.74 versus 1.17 ؎ 0.39). Despite similar plasma pharmacokinetics, patients with empyema/parapneumonic effusion showed a significant delay in achievement of PF maximum MXF levels compared to those with malignant effusion. However, in both groups, the degree of MXF PF penetration and the on-site drug exposure, expressed by AUC 24PF , did not differ according to the type of pleural effusion.

Pleural Fluid Penetration of Moxifloxacin and Doripenem: An Experimental Model of Empyema

“…We have found only one publication in the literature. Animal and human results were similar [11]. We wanted to compare the commonly used and proven moxifloxacin with Doripenem.…”

“…The mortality rate for older adults with the underlying diseases has reached up to 30%. This may be related to weak underlying conditions of patients, inappropriate antibiotic selection or antimicrobial resistance and other factors [10,11]. These changes are likely to increase the awareness of clinical diagnosis and the number of better diagnostic methods.…”

“…In pleural infection, pleural effusions can be quickly evolved from uncomplicated parapneumonic effusions to empyema. Classically, empyema is divided into three stages: exudative, fibrin exudation & pus formation and organization stage [11]. In the exudative period of empyema, pleural fluid accumulates due to the increased permeability of the visceral pleura.…”

Аrginase/NO-synthase system сharacteristics in blood lymphocytes under effect of fluoroquinolones

“…Fluoroquinolones of the III and IV generations are highly effective against anaerobes, in particular, moxifloxacin is effective against pneumococci, and prevails over all other fluoroquinolones and antibiotics such as ben-zylpenicillin, erythromycin, tetracycline, etc. (Werber et al, 2005;Potjo et al, 2010;Chatzika et al, 2014;Majhi et al, 2014;Demir et al, 2018).…”

Effect of Fluoroquinolones on the Activity of the Glutathione System in the Peripheral Blood Lymphocytes

“…The pharmacodynamics of fluoroquinolones include antibacterial (bacteriocidal), postantibiotic and immunomodulatory effects [7,8]. Drugs 2nd generations (for example, ciprofloxacin) are active in a wide range of gram-negative aerobic microorganisms as well as Staphylococcus aureus, salmonella, Escherichia coli [6].…”