Fourth-generation Fluoroquinolones Moxifloxacin Research Articles

The effectiveness of moxifloxacin in the treatment of community-acquired pneumonia

The article presents the results of domestic and international studies of the use of the fourth-generation fluoroquinolone moxifloxacin in the treatment of commu-nity-acquired pneumonia and pneumonia caused by SARS-CoV-2. Analysis of the clinical use of moxifloxacin in the treatment of complications of the respiratory tract infec-tions indicates its high efficiency and bioavailability, a low risk of resistance, which makes it possible to recommend it for widespread use in the work of a practicing doctor. Ge-neric drug Maxicin (Yuria-Pharm), available as a 20 mg/ml concentrate in a 20 ml vial, can significantly reduce the cost of treatment and optimize infusion therapy by choosing both volume and solvent.

Small pelvic inflammatory diseases: Diagnosis and patient management tactics

Small pelvic inflammatory diseases (endometritis, salpingitis, tubo-ovarian abscess, and pelvioperitonitis) in women of childbearing age are most common. Analysis of U.S. and European guidelines for the management of patients with small pelvic inflammatory diseases and research articles from journals has provided criteria (minimum additional, specific) for the diagnosis of these diseases, those for their out- or inpatient treatment, and principles in the treatment of these patents. The management of these patients should be comprehensive, but based on rational empiric antibiotic therapy. The general principles of antimicrobial therapy should be as follows: 1) as early onset as possible; 2) 10—14-day antibiotic use covering the full spectrum of probable causative agents; 3) outpatient oral antibiotic treatment for mild and moderate small pelvic inflammatory diseases. Only inpatient parenteral antibiotic treatment should be performed in patients with severe forms and, if their condition improves, it may be switched over to oral antibiotics in 1—2 days. The fourth-generation fluoroquinolone moxifloxacin is shown to be highly effective in treating this patient group. The authors declare no conflicts of interest.

Orofacial Dyskinesia After Moxifloxacin Treatment—A Case With Normal Hepatorenal Function and Review of Literature

Orofacial dyskinesia is rarely reported with antibiotics. Among antibiotics, third-generation fluoroquinolones are known to cause movement disorders. We report the first patient who developed orofacial dyskinesia after taking a fourth-generation fluoroquinolone, namely, moxifloxacin. The patient is a 58-year-old woman who was treated with moxifloxacin for acute bronchitis. She developed orofacial dyskinesia involving the tongue, lips, and facial muscles after treatment. Discontinuation of moxifloxacin and treatment with clonidine resulted in significant reduction of orofacial dyskinesia over the period of 8 to 12 weeks. A review of literature shows reports of a variety of involuntary movements with third-generation fluoroquinolones, mostly manifesting in patients with impaired renal and kidney function. The fourth-generation fluoroquinolone moxifloxacin can cause orofacial dyskinesia like third-generation fluoroquinolone antibiotics and in a patient with normal renal and liver function.

Fluoroquinolone antibacterial eye drops: effects on normal human corneal epithelium, stroma, and endothelium

BackgroundIn vitro studies have suggested the corneal cytotoxicity of third-generation fluoroquinolone levofloxacin (LVFX) and fourth-generation fluoroquinolone moxifloxacin hydrochloride (MFLX) among fluoroquinolone antibacterial eye drops. This study investigated the effects of these two eye drops on the human cornea in vivo.MethodsWe evaluated 30 healthy adults (19 men and 11 women, 38.3 ± 6.3 years old). Each subject received an LVFX ophthalmic solution 0.5% in one eye and an MFLX ophthalmic solution 0.5% in the other eye three times daily for 7 days. Functional and morphological corneal changes before and after instillation were evaluated through ophthalmic examinations including breakup time of tear film (BUT) as measured by fluorescein staining and DR-1, Schirmer I test, Heidelberg Retina Tomograph II Rostock Cornea Module (HRTII-RCM), specular microscope, and Pentacum examination.ResultsBoth the LVFX and MFLX groups had no significant change in each examination before and after instillation. There was also no statistically significant difference in measurements after the 7-day instillation between the groups.ConclusionOur study results suggest that as with LVFX, MFLX used in a normal clinical setting is unlikely to cause any obvious adverse effects on human normal cornea.

Contact lens-associated microbial keratitis

Contact lens-associated microbial keratitis is a severe condition with sight-threatening potential and increasing incidence. Information regarding the etiological agents is essential in guiding management and may vary geographically. The aim of this study was to analyze the microbiological results of corneal scrapings collected from patients presenting with contact lens-associated microbial keratitis. Retrospective analysis of the records of all patients who were clinically diagnosed with contact lens-associated microbial keratitis and had corneal scrapings sent to the Laboratory of Ocular Microbiology, UNIFESP/EPM during a 5-year period from January 2002 to December 2007. The etiological agent was identified in 239 patients. Bacterial isolates accounted for 166 (69.46%) cases, Acanthamoeba for 95 (39.75%) cases and fungi for 4 (1.67%) cases. Among the bacterial infections, coagulase-negative Staphylococcus was demonstrated in 74 cases, while Pseudomonas spp was found in 32 patients. All coagulase negative Staphylococcus and Pseudomonas were susceptible to ciprofloxacin and ofloxacin. Resistance to gentamicin was documented in a single case of Pseudomonas. Fourth-generation flouoroquinolone resistance was not observed among Pseudomonas cases. Coagulase-negative Staphylococcus was the most frequent isolate, and such data must be considered when determining empiric treatment. Second-generation fluoroquinolones ciprofloxacin and ofloxacin and fourth-generation fluoroquinolones moxifloxacin and gatifloxacin showed a good antibacterial profile and therefore could be good options for initial management.

Fourth-Generation Fluoroquinolone Penetration into the Aqueous Humor in Humans

To compare the penetration and levels of the fourth-generation fluoroquinolones moxifloxacin 0.5% ophthalmic solution and gatifloxacin 0.3% solution in the aqueous humor (AH) in humans after topical application with published levels of other available fluoroquinolones under similar dosing conditions. Prospective, randomized, double-masked clinical trial. Forty-six patients undergoing cataract extraction. Patients scheduled for routine phacoemulsification and intraocular lens implantation were provided either moxifloxacin 0.5% ophthalmic solution (n = 22) or gatifloxacin 0.3% ophthalmic solution (n = 24) to use 4 times daily the day before surgery plus 1 drop 1 hour before the surgical entry into the anterior chamber on the day of surgery. This regimen simulated a realistic postoperative dosing schedule. Aqueous humor samples were obtained and analyzed by high-pressure liquid chromatography. Aqueous humor fluoroquinolone concentrations were calculated by peak comparison with a known concentration peak for ciprofloxacin that was used as an internal standard. These values were compared with published concentrations of other available fluoroquinolones under similar dosing conditions. The mean age of the moxifloxacin 0.5% group was 67.8+/-9.7 years, whereas that of the gatifloxacin 0.3% group was 69.9+/-8.7 years. The moxifloxacin AH concentration was 1.86+/-1.06 microg/ml, and that of gatifloxacin was 0.94+/-0.72 microg/ml. This 2-fold difference was statistically significant (P = 0.001). Aqueous humor antibiotic concentrations achieved at the time of cataract surgery after topical application can serve as an effective surrogate for what can be achieved with typical postoperative topical dosing (e.g., 4 times daily). Both fourth-generation fluoroquinolones achieved a greater AH concentration after 4 times daily dosing relative to prior-generation fluoroquinolones. Moxifloxacin 0.5% ophthalmic solution achieved a 2-fold higher aqueous humor concentration than gatifloxacin 0.3% ophthalmic solution. The superior penetration of moxifloxacin into the AH may be attributed partially to its high degree of lipophilicity, greater solubility at neutral pH, and higher concentration in the commercial formulation. The enhanced penetration of moxifloxacin 0.5% ophthalmic solution may provide better protection against ocular infections.

Fourth-generation fluoroquinolones in the treatment of mycobacterial infectious keratitis after laser-assisted in situ keratomileusis surgery

Case report: Infectious keratitis after laser-assisted in situ keratomileusis (LASIK) is a rare complication that may be challenging to diagnose and treat.We discuss some of the reasons for difficulties diagnosing postoperative atypical or nontuberculous mycobacterial infection and establishing an effective treatment, with reference to reports of comparative antibacterial activity of the most commonly used antibiotics. Comments: To the best of our knowledge, we are the first to report the use of the fourth-generation fluoroquinolone moxifloxacin in combination therapy for the successful treatment of this condition.

Comparative penetration of moxifloxacin and gatifloxacin in rabbit aqueous humor after topical dosing

Purpose: To evaluate the aqueous penetration of the fourth-generation fluoroquinolones moxifloxacin and gatifloxacin. Setting: University of Arizona, Tucson, Arizona, USA. Methods: Forty eyes of 20 New Zealand white rabbits were divided into 2 experimental groups. In Experiment I rabbits (20 eyes), a commercial preparation of topical gatifloxacin 0.3% was administered to 9 eyes and moxifloxacin 0.5% to 9 eyes; 2 eyes served as a control. Eyes were dosed according to a keratitis protocol; ie, every 15 minutes for 4 hours. The aqueous humor was sampled 10 minutes after the last dose. Experiment II rabbits (20 eyes) were dosed according to a cataract prophylaxis protocol; ie, 4 times a day for 10 days. The aqueous humor was sampled 1 hour after the last dose of antibiotic in 12 eyes and 24 hours after the last dose in 8 eyes. High-performance liquid chromatography was used to determine the fluoroquinolone concentration. Results: In the keratitis dosing protocol, the mean concentration of moxifloxacin in the aqueous (n = 9) was 11.057 μg/mL (range 7.66 to 18.87 μg/mL), which was significantly higher than the mean concentration of gatifloxacin (n = 8) (7.570 μg/mL [range 4.75 to 10.86 μg/mL]) ( P = .030). In the cataract prophylaxis dosing protocol, the mean aqueous concentration of moxifloxacin (n = 6) was 1.745 μg/mL (range 0.92 to 3.87 mg/mL). The mean concentration of gatifloxacin (n = 6) was 1.207 μg/mL (range 0.44 to 2.44 μg/mL). The difference was not statistically significant ( P = .359). Conclusions: Higher mean levels (×1.46) of aqueous penetration were achieved with moxifloxacin than with gatifloxacin in the keratitis-dosing model. There was no statistically significant difference between the 2 drugs in the cataract prophylaxis dosing model. Both antibiotics had aqueous levels in excess of the minimum inhibitory concentration for most pathogenic organisms in both models.