Maternal blood and amniotic fluid levels of moxifloxacin, levofloxacin and cefixime

Abstract

Moxifloxacin and levofloxacin are wide spectrum quinolones and cefixime is a third-generation cephalosporin with a wider spectrum of activity against gram-positive and gram-negative bacteria and anaerobics. Although they are widely used, little is known about the amniotic fluid levels of these antibiotics. The aim of the present investigation was to study and compare the maternal blood and amniotic fluid levels of these antibiotics in second trimester pregnancy. To assess the amniotic fluid levels of these antibiotics, 10 pregnant women were given moxifloxacin, 10 were given levofloxacin and 6 were given cefixime orally 2 h before amniocentesis as a single dose for prophylaxis. During amniocentesis, an extra 2 mL amniotic fluid sample and 2 mL maternal venous blood were drawn. The levels of these agents in samples were analyzed using high performance liquid chromatography. The amniotic fluid levels of moxifloxacin and levofloxacin were 0.27 +/- 0.21 microg/mL and 0.60 +/- 0.41 microg/mL, respectively. The maternal blood levels were 3.53 +/- 0.65 microg/mL and 3.95 +/- 0.77 microg/mL in the moxifloxacin and levofloxacin groups, respectively. The maternal blood level of cefixime was 2.59 +/- 1.10 microg/mL and the amniotic fluid level was 0.85 +/- 0.42 microg/mL. The amniotic fluid passage rates were 7.83% for moxifloxacin, 15.67% for levofloxacin and 37.55% for cefixime. Of these three antibiotics, cefixime has the highest transplacental passage rate and, therefore, can be used as a therapeutic agent in infectious conditions in which membranes and the placenta are involved. Moxifloxacin and levofloxacin have low passage rates, which should be considered when using as a therapeutic agent.