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Liu HX, Tang BH, van den Anker J, Hao GX, Zhao W, Zheng Y. Population pharmacokinetics of antibacterial agents in the older population: a literature review. Expert Rev Clin Pharmacol 2024; 17:19-31. [PMID: 38131668 DOI: 10.1080/17512433.2023.2295009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Older individuals face an elevated risk of developing bacterial infections. The optimal use of antibacterial agents in this population is challenging because of age-related physiological alterations, changes in pharmacokinetics (PK) and pharmacodynamics (PD), and the presence of multiple underlying diseases. Therefore, population pharmacokinetics (PPK) studies are of great importance for optimizing individual treatments and prompt identification of potential risk factors. AREA COVERED Our search involved keywords such as 'elderly,' 'old people,' and 'geriatric,' combined with 'population pharmacokinetics' and 'antibacterial agents.' This comprehensive search yielded 11 categories encompassing 28 antibacterial drugs, including vancomycin, ceftriaxone, meropenem, and linezolid. Out of 127 studies identified, 26 (20.5%) were associated with vancomycin, 14 (11%) with meropenem, and 14 (11%) with piperacillin. Other antibacterial agents were administered less frequently. EXPERT OPINION PPK studies are invaluable for elucidating the characteristics and relevant factors affecting the PK of antibacterial agents in the older population. Further research is warranted to develop and validate PPK models for antibacterial agents in this vulnerable population.
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Affiliation(s)
- Hui-Xin Liu
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bo-Hao Tang
- Department of Pharmacy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - John van den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, USA
- Departments of Pediatrics, Pharmacology & Physiology, Genomics and Precision Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Department of Paediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Guo-Xiang Hao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Zhao
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Pharmacy, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Clinical Pharmacy, Clinical Trial Center, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, China
| | - Yi Zheng
- Department of Clinical Pharmacy, Institute of Clinical Pharmacology, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
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Ito F, Ohno Y, Toyoshi S, Kaito D, Koumei Y, Endo J, Kamamiya F, Mori H, Mori M, Morishita M, Funaguchi N, Minatoguchi S. Pharmacokinetics of consecutive oral moxifloxacin (400 mg/day) in patients with respiratory tract infection. Ther Adv Respir Dis 2015; 10:34-42. [PMID: 26660898 DOI: 10.1177/1753465815620338] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A population pharmacokinetic analysis was performed to investigate the pharmacokinetics of moxifloxacin (400 mg) following a once-daily oral administration in 28 patients with respiratory tract infection disease. The maximum plasma concentration and the area under the plasma concentration-time curve were 3.97 µg/ml and 51.74 µg·h/ml, respectively; these values were nearly equivalent to those of healthy adult men. Two adverse drug reactions (nausea, vomiting) occurred, but both reactions were mild and nonserious and the patients recovered without treatment. The pharmacokinetic profile of moxifloxacin in Japanese patients with respiratory tract infection and an underlying disease should thus be considered safe and comparable with that in healthy adult men, and adjustment of dose may do not need for age, sex, body weight, or renal function.
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Affiliation(s)
- Fumitaka Ito
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasushi Ohno
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Sayaka Toyoshi
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Daizo Kaito
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yanase Koumei
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Junki Endo
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Fumihiko Kamamiya
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hidenori Mori
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahiro Mori
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Megumi Morishita
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Norihiko Funaguchi
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shinya Minatoguchi
- Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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Kuzman I, Bezlepko A, Kondova Topuzovska I, Rókusz L, Iudina L, Marschall HP, Petri T. Efficacy and safety of moxifloxacin in community acquired pneumonia: a prospective, multicenter, observational study (CAPRIVI). BMC Pulm Med 2014; 14:105. [PMID: 24975809 PMCID: PMC4105837 DOI: 10.1186/1471-2466-14-105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/18/2014] [Indexed: 01/12/2023] Open
Abstract
Background Community acquired pneumonia (CAP) is a major cause of morbidity, hospitalization, and mortality worldwide. Management of CAP for many patients requires rapid initiation of empirical antibiotic treatment, based on the spectrum of activity of available antimicrobial agents and evidence on local antibiotic resistance. Few data exist on the severity profile and treatment of hospitalized CAP patients in Eastern and Central Europe and the Middle East, in particular on use of moxifloxacin (Avelox®), which is approved in these regions. Methods CAPRIVI (Community Acquired Pneumonia: tReatment wIth AVelox® in hospItalized patients) was a prospective observational study in 12 countries: Croatia, France, Hungary, Kazakhstan, Jordan, Kyrgyzstan, Lebanon, Republic of Moldova, Romania, Russia, Ukraine, and Macedonia. Patients aged >18 years were treated with moxifloxacin 400 mg daily following hospitalization with a CAP diagnosis. In addition to efficacy and safety outcomes, data were collected on patient history and disease severity measured by CRB-65 score. Results 2733 patients were enrolled. A low severity index (i.e., CRB-65 score <2) was reported in 87.5% of CAP patients assessed (n = 1847), an unexpectedly high proportion for hospitalized patients. Moxifloxacin administered for a mean of 10.0 days (range: 2.0 to 39.0 days) was highly effective: 96.7% of patients in the efficacy population (n = 2152) improved and 93.2% were cured of infection during the study. Severity of infection changed from “moderate” or “severe” in 91.8% of patients at baseline to “no infection” or “mild” in 95.5% at last visit. In the safety population (n = 2595), 127 (4.9%) patients had treatment-emergent adverse events (TEAEs) and 40 (1.54%) patients had serious TEAEs; none of these 40 patients died. The safety results were consistent with the known profile of moxifloxacin. Conclusions The efficacy and safety profiles of moxifloxacin at the recommended dose of 400 mg daily are characterized in this large observational study of hospitalized CAP patients from Eastern and Central Europe and the Middle East. The high response rate in this study, which included patients with a range of disease severities, suggests that treatment with broader-spectrum drugs such as moxifloxacin is appropriate for patients with CAP who are managed in hospital. Trial registration ClinicalTrials.gov identifier: NCT00987792
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Affiliation(s)
- Ilija Kuzman
- University of Zagreb School of Medicine, University Hospital for Infectious Diseases "Dr, Fran Mihaljević", Mirogojska cesta 8, 10000 Zagreb, Croatia.
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Lode HM. Preserving the efficacy of front-line fluoroquinolones through selective use to optimise clinical outcomes. Int J Antimicrob Agents 2014; 43:497-507. [DOI: 10.1016/j.ijantimicag.2014.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 01/06/2023]
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Liu KX, Xu B, Wang J, Zhang J, Ding HB, Ariani F, Qu JM, Lin QC. Efficacy and safety of moxifloxacin in acute exacerbations of chronic bronchitis and COPD: a systematic review and meta-analysis. J Thorac Dis 2014; 6:221-9. [PMID: 24624286 DOI: 10.3978/j.issn.2072-1439.2013.11.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 11/20/2013] [Indexed: 11/14/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of moxifloxacin in acute exacerbations of chronic bronchitis (AECB) and chronic obstructive pulmonary disease (AECOPD). METHODS We searched PubMed, EMBASE, and the Web of Science for relevant studies. Two reviewers extracted data and reviewed the quality of the studies independently. The primary outcome was clinical success at early follow-up. Study-level data were pooled using a random-effects model when I(2) was >50% or a fixed-effects model when I(2) was <50%. RESULTS Eleven randomized controlled studies were considered. There was no difference between moxifloxacin and comparator agents with regard to treatment success in intention-to-treat (ITT) [odds ratio (OR) =1.18, 95% confidence interval (CI) 0.98-1.42], clinically evaluable (CE) (OR 1.13, 95% CI, 0.93-1.37) patients, or adverse effects in general (OR 1.00, 95% CI, 0.86-1.17). Moxifloxacin was associated with better microbiological success (OR 1.45; 95% CI, 1.14-1.85). CONCLUSIONS Moxifloxacin was as clinically equivalent and bacteriologically superior to the antibiotic regimens routinely used in patients with AECB and AECOPD. Moxifloxacin therapy may be a promising and safe alternative to empirical treatment for AECB and AECOPD.
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Affiliation(s)
- Kai-Xiong Liu
- 1 Department of Respiratory disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China ; 2 Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China ; 3 Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China ; 4 Department of Respiratory Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai 200040, China ; 5 Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical School of Fudan University, Shanghai 200032, China
| | - Bing Xu
- 1 Department of Respiratory disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China ; 2 Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China ; 3 Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China ; 4 Department of Respiratory Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai 200040, China ; 5 Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical School of Fudan University, Shanghai 200032, China
| | - Jie Wang
- 1 Department of Respiratory disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China ; 2 Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China ; 3 Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China ; 4 Department of Respiratory Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai 200040, China ; 5 Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical School of Fudan University, Shanghai 200032, China
| | - Jing Zhang
- 1 Department of Respiratory disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China ; 2 Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China ; 3 Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China ; 4 Department of Respiratory Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai 200040, China ; 5 Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical School of Fudan University, Shanghai 200032, China
| | - Hai-Bo Ding
- 1 Department of Respiratory disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China ; 2 Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China ; 3 Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China ; 4 Department of Respiratory Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai 200040, China ; 5 Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical School of Fudan University, Shanghai 200032, China
| | - Felinda Ariani
- 1 Department of Respiratory disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China ; 2 Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China ; 3 Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China ; 4 Department of Respiratory Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai 200040, China ; 5 Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical School of Fudan University, Shanghai 200032, China
| | - Jie-Ming Qu
- 1 Department of Respiratory disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China ; 2 Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China ; 3 Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China ; 4 Department of Respiratory Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai 200040, China ; 5 Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical School of Fudan University, Shanghai 200032, China
| | - Qi-Chang Lin
- 1 Department of Respiratory disease, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China ; 2 Laboratory of Respiratory Disease of Fujian Medical University, Fuzhou 350005, China ; 3 Department of Neurology, Fujian Geriatric Hospital, Fuzhou 350003, China ; 4 Department of Respiratory Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai 200040, China ; 5 Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical School of Fudan University, Shanghai 200032, China
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Burkhardt O, Welte T. 10 years’ experience with the pneumococcal quinolone moxifloxacin. Expert Rev Anti Infect Ther 2014; 7:645-68. [DOI: 10.1586/eri.09.46] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Are Fluoroquinolones Superior Antibiotics for the Treatment of Community-Acquired Pneumonia? Curr Infect Dis Rep 2012; 14:317-29. [DOI: 10.1007/s11908-012-0251-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Efficacy and safety of moxifloxacin for community-acquired bacterial pneumonia based on pharmacokinetic analysis. J Infect Chemother 2011; 17:678-85. [PMID: 21847518 DOI: 10.1007/s10156-011-0282-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 06/30/2011] [Indexed: 10/17/2022]
Abstract
Moxifloxacin is a respiratory quinolone that is expected to be useful for treating community-acquired bacterial pneumonia, but few clinical studies and not a detailed evaluation of its pharmacokinetics have been conducted in Japan in patients with pneumonia. We assessed the efficacy and safety of moxifloxacin in 18 patients with community-acquired bacterial pneumonia using pharmacokinetic-pharmacodynamic analysis. There was significant improvement in body temperature, white blood cell count, C-reactive protein, and chest X-ray score on day 3 of moxifloxacin treatment, which persisted until the completion of treatment (all p < 0.05). Nine strains, including Streptococcus pneumoniae, Moraxella catarrhalis, Haemophilus influenzae, and Enterobacter cloacae, were isolated from sputum cultures of nine patients. The isolated strains were eradicated by moxifloxacin. The mean area under the concentration-time curve from 0 to 24 hours [AUC(0-24 h) (AUC(0-24 h,ss))], maximum plasma concentration (C(max)), and trough plasma level (C(trough)) of moxifloxacin at steady state was 52.0 μg h/ml, 4.5, and 0.9 μg/ml, respectively. Mean AUC(0-24 h,ss)/mimimum inhibitory concentration (MIC), and C(max)/MIC ratios for patients in whom MICs of moxifloxacin were determined for pathogenic bacteria were 723 and 62, respectively. The median AUC(0-24 h,ss)/MIC and C(max)/MIC ratios (based on Monte Carlo simulation employing MICs for 257 strains of S. pneumoniae collected during a respiratory infection survey by the Japanese Society of Chemotherapy in 2007) were 209.56 and 17.88, respectively. Thus, when the target for the AUC/MIC ratio was set at ≥30 and that for the C(max)/MIC ratio at ≥5, the achievement rate for these two parameters was 97.36% and 96.71%, respectively. Two patients (11%) experienced three adverse effects [one nausea, another increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], but the events were not serious. Based on these results, moxifloxacin (400 mg once daily) was considered useful for treating community-acquired bacterial pneumonia and is expected to show excellent efficacy and safety as well as suppressing the emergence of resistance.
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Wispelwey B, Schafer KR. Fluoroquinolones in the management of community-acquired pneumonia in primary care. Expert Rev Anti Infect Ther 2011; 8:1259-71. [PMID: 21073291 DOI: 10.1586/eri.10.110] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A literature search was conducted to evaluate the pharmacokinetic and pharmacodynamic profile of the respiratory fluoroquinolones (gemifloxacin, levofloxacin and moxifloxacin) and their efficacy and safety in the management of community-acquired pneumonia (CAP). Data show that CAP is a common presentation in primary care practice, and is associated with high rates of morbidity and mortality, particularly in the elderly. Although the causative pathogens differ depending on treatment setting and patient factors, Streptococcus pneumoniae is the primary pathogen in all treatment settings. As a class, the respiratory fluoroquinolones have a very favorable pharmacokinetic and pharmacodynamic profile. Pharmacodynamic criteria suggest that moxifloxacin and gemifloxacin are more potent against S. pneumoniae, which may have the added benefit of reducing resistance selection and enhancing bacterial eradication. The respiratory fluoroquinolones are also generally well tolerated, and are first-line options for outpatient treatment of CAP in patients with comorbidities or previous antibiotic use.
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Affiliation(s)
- Brian Wispelwey
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health Center, P.O. Box 801337, Charlottesville, VA 22908-1337, USA.
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Vanhoof R, Camps K, Carpentier M, De Craeye S, Frans J, Glupczynski Y, Goffinet P, Gordts B, Govaerts D, Ide L, Lefèvre P, Lontie M, Cartuyvels R, Meunier F, Mulongo B, Philippart I, Surmont I, Van Bossuyt E, Van Eldere J, Verhaegen J. 10th Survey of antimicrobial resistance in noninvasive clinical isolates of Streptococcus pneumoniae collected in Belgium during winter 2007–2008. ACTA ACUST UNITED AC 2010; 58:147-51. [DOI: 10.1016/j.patbio.2009.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022]
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Siempos II, Dimopoulos G, Falagas ME. Meta-analyses on the Prevention and Treatment of Respiratory Tract Infections. Infect Dis Clin North Am 2009; 23:331-53. [DOI: 10.1016/j.idc.2009.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ryan RJ, Lindsell C, Sheehan P. Fluoroquinolone resistance during 2000-2005: an observational study. BMC Infect Dis 2008; 8:71. [PMID: 18501015 PMCID: PMC2424048 DOI: 10.1186/1471-2334-8-71] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 05/24/2008] [Indexed: 12/02/2022] Open
Abstract
Background Moxifloxacin is a respiratory fluoroquinolone with a community acquired pneumonia indication. Unlike other fluoroquinolones used in our healthcare system, moxifloxacin's urinary excretion is low and thus we hypothesized that increased use of moxifloxacin is associated with an increase in fluoroquinolone resistance amongst gram negative uropathogens. Methods All antibiograms for Gram negative bacteria were obtained for 2000 to 2005. The defined daily dose (DDD) for each fluoroquinolone was computed according to World Health Organization criteria. To account for fluctuation in patient volume, DDD/1000 bed days was computed for each year of study. Association between DDD/1000 bed days for each fluoroquinolone and the susceptibility of Gram negative bacteria to ciprofloxacin was assessed using Pearson's Correlation Coefficient, r. Results During the study period, there were 48,261 antibiograms, 347,931 DDD of fluoroquinolones, and 1,943,338 bed days. Use of fluoroquinolones among inpatients decreased from 237.2 DDD/1000 bed days in 2000 to 115.2 DDD/1000 bed days in 2005. With the exception of Enterobacter aerogenes, moxifloxacin use was negatively correlated with sensitivity among all 13 Gram negative species evaluated (r = -0.07 to -0.97). When the sensitivities of all Gram negative organisms were aggregated, all fluoroquinolones except moxifloxacin were associated with increased sensitivity (r = 0.486 to 1.000) while moxifloxacin was associated with decreased sensitivity (r = -0.464). Conclusion Moxifloxacin, while indicated for empiric treatment of community acquired pneumonia, may have important negative influence on local antibiotic sensitivities amongst Gram negative organisms. This effect was not shared by other commonly used members of the fluoroquinolone class.
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Affiliation(s)
- Richard J Ryan
- Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, Ohio 45267-0769, USA.
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Torres A, Garau J, Arvis P, Carlet J, Choudhri S, Kureishi A, Le Berre M, Lode H, Winter J, Read R. Moxifloxacin Monotherapy Is Effective in Hospitalized Patients with Community‐Acquired Pneumonia: The MOTIV Study—A Randomized Clinical Trial. Clin Infect Dis 2008; 46:1499-509. [DOI: 10.1086/587519] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Mattar CS, Keith RL, Byrd RP, Roy TM. Septic pulmonary emboli due to periodontal disease. Respir Med 2006; 100:1470-4. [PMID: 16376534 DOI: 10.1016/j.rmed.2005.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 10/26/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
Septic pulmonary embolization (SPE) is a rare but serious disorder. It is a well-recognized potential problem in the settings of tricuspid valve endocarditis, septic thrombophlebitis, infected central venous catheters, and postanginal septicemia. Less well documented is the occurrence of SPE in patients with periodontal disease without suppurative thrombophlebitis of the great vessels of the neck. We report a patient with SPE in whom periodontal disease was the only identifiable nidus of infection and review the literature regarding the four other patients reported to have suffered this complication.
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Affiliation(s)
- Costy S Mattar
- The Veterans Affairs Medical Center 111-B, P.O. Box 4000, Mountain Home, TN 37684-4000, and Division of Pulmonary Diseases and Critical Care Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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