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Kuo CY, Garcia-Lloret MI, Slev P, Bohnsack JF, Chen K. Profound T-cell lymphopenia associated with prenatal exposure to purine antagonists detected by TREC newborn screening. J Allergy Clin Immunol Pract 2018; 5:198-200. [PMID: 28065337 DOI: 10.1016/j.jaip.2016.09.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/02/2016] [Accepted: 09/20/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Caroline Y Kuo
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif.
| | - Maria I Garcia-Lloret
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, Calif
| | - Patricia Slev
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah; Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah
| | - John F Bohnsack
- Department of Allergy and Immunology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Karin Chen
- Department of Allergy and Immunology, University of Utah School of Medicine, Salt Lake City, Utah
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2
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Abstract
Objective: To report a case of torsade de pointes in a patient receiving moxifloxacin. Case Summary: An 87-year-old woman was admitted to the hospital for pneumonia, and antibiotic therapy with intravenous moxifloxacin 400 mg/day was initiated. The patient was noted to have significant QTc interval prolongation 2 hours after administration of moxifloxacin and developed torsade de pointes 8–10 hours after moxifloxacin administration. She was converted back to normal sinus rhythm after a precordial thump. Moxifloxacin was discontinued, and the woman's QTc interval subsequently returned to baseline. Discussion: Torsade de pointes is a life-threatening arrhythmia that has previously been associated with the use of fluoroquinolones. Minimal information is available regarding the risk of torsade de pointes with moxifloxacin. According to the Naranjo probability scale, the episode in this case was probably related to administration of intravenous moxifloxacin. Conclusions: In patients with underlying risk factors for a prolonged QT interval, the use of moxifloxacin can lengthen the interval further and ultimately trigger episodes of torsade de pointes. Moxifloxacin administration in these patients therefore should be administered and monitored judiciously.
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Affiliation(s)
- Krista M Dale
- Division of Cardiology, School of Pharmacy, University of Connecticut, Hartford, CT, USA
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3
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Biller P, Shank B, Lind L, Brennan M, Tkatch L, Killgore G, Thompson A, McDonald LC. Moxifloxacin Therapy as a Risk Factor forClostridium difficile–Associated Disease During an Outbreak: Attempts to Control a New Epidemic Strain. Infect Control Hosp Epidemiol 2015; 28:198-201. [PMID: 17265402 DOI: 10.1086/511789] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Accepted: 04/10/2006] [Indexed: 11/03/2022]
Abstract
An outbreak ofClostridium difficile-associated disease (CDAD) caused by the epidemic North American pulsed-field gel electrophoresis type 1 (NAP1) strain began after a formulary change from levofloxacin to moxifloxacin. Cases of CDAD were associated with moxifloxacin use, but a formulary change back to levofloxacin failed to reduce rates of disease. Substituting use of one fluoroquinolone with use of another without also controlling the overall use of drugs from this class is unlikely to control outbreaks caused by the NAP1 strain ofC. difficile.
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Khan AA, Afzal M, Qureshi JA, Khan AM, Raza AM. Botanicals, selective insecticides, and predators to control Diaphorina citri (Hemiptera: Liviidae) in citrus orchards. Insect Sci 2014; 21:717-726. [PMID: 25205398 DOI: 10.1111/1744-7917.12173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 06/03/2023]
Abstract
The Asian citrus psyllid (ACP) Diaphorina citri Kuwayama vectors pathogens that cause huanglongbing (HLB) or citrus greening devastating and economically important disease present in most citrus growing regions. Young citrus shoots are required for psyllid reproduction and development. During winter citrus trees produce little or no new growth. Overwintering adults reproduce in spring on newly emerging shoots also attractive to other pests and beneficial insects. Botanicals and relatively selective insecticides could help to conserve beneficial insects and reduce pest resistance to insecticides. Sprays of Azadirachtin (Neem), Tropane (Datura), Spirotetramat, Spinetoram, and broad-spectrum Imidacloprid were evaluated to control ACP in spring and summer on 10-year-old "Kinow" Citrus reticulata Blanco trees producing new growth. Psyllid populations were high averaging 5-9 nymphs or adults per sample before treatment application. Nymphs or adults were significantly reduced to 0.5-1.5 per sample in all treatments for 3 weeks, average 61%-83% reduction. No significant reduction in ladybeetles Adalia bipunctata, Aneglei scardoni, Cheilomenes sexmaculata, and Coccinella septempunctata was observed. Syrphids, spiders and green lacewings were reduced in treated trees except with Tropane. Studies are warranted to assess impact of these predators on ACP and interaction with insecticides. Observed reduction in ACP populations may not be enough considering its reproductive potential and role in the spread of HLB. Follow-up sprays may be required to achieve additional suppression using rotations of different insecticides.
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Affiliation(s)
- Azhar A Khan
- Department of Agricultural Entomology, University of Sargodha, Sargodha, Pakistan
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Chain ASY, Dubois VFS, Danhof M, Sturkenboom MCJM, Della Pasqua O. Identifying the translational gap in the evaluation of drug-induced QTc interval prolongation. Br J Clin Pharmacol 2013; 76:708-24. [PMID: 23351036 PMCID: PMC3853530 DOI: 10.1111/bcp.12082] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 01/13/2013] [Indexed: 10/27/2022] Open
Abstract
AIMS Given the similarities in QTc response between dogs and humans, dogs are used in pre-clinical cardiovascular safety studies. The objective of our investigation was to characterize the PKPD relationships and identify translational gaps across species following the administration of three compounds known to cause QTc interval prolongation, namely cisapride, d, l-sotalol and moxifloxacin. METHODS Pharmacokinetic and pharmacodynamic data from experiments in conscious dogs and clinical trials were included in this analysis. First, pharmacokinetic modelling and deconvolution methods were applied to derive drug concentrations at the time of each QT measurement. A Bayesian PKPD model was then used to describe QT prolongation, allowing discrimination of drug-specific effects from other physiological factors known to alter QT interval duration. A threshold of ≥10 ms was used to explore the probability of prolongation after drug administration. RESULTS A linear relationship was found to best describe the pro-arrhythmic effects of cisapride, d,l-sotalol and moxifloxacin both in dogs and in humans. The drug-specific parameter (slope) in dogs was statistically significantly different from humans. Despite such differences, our results show that the probability of QTc prolongation ≥10 ms in dogs nears 100% for all three compounds at the therapeutic exposure range in humans. CONCLUSIONS Our findings indicate that the slope of PKPD relationship in conscious dogs may be used as the basis for the prediction of drug-induced QTc prolongation in humans. Furthermore, the risk of QTc prolongation can be expressed in terms of the probability associated with an increase ≥10 ms, allowing direct inferences about the clinical relevance of the pro-arrhythmic potential of a molecule.
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Affiliation(s)
- Anne SY Chain
- Leiden/Amsterdam Center for Drug Research, Division of Pharmacology, Leiden UniversityLeiden, the Netherlands
| | - Vincent FS Dubois
- Leiden/Amsterdam Center for Drug Research, Division of Pharmacology, Leiden UniversityLeiden, the Netherlands
| | - Meindert Danhof
- Leiden/Amsterdam Center for Drug Research, Division of Pharmacology, Leiden UniversityLeiden, the Netherlands
| | - Miriam CJM Sturkenboom
- Department of Medical Informatics, Erasmus Medical CenterRotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical CenterRotterdam, the Netherlands
| | - Oscar Della Pasqua
- Leiden/Amsterdam Center for Drug Research, Division of Pharmacology, Leiden UniversityLeiden, the Netherlands
- Clinical Pharmacology and Discovery Medicine, GlaxoSmithKlineUxbridge, UK
| | - on behalf of the Cardiovascular Safety Project Team, TI Pharma PKPD Platform
- Leiden/Amsterdam Center for Drug Research, Division of Pharmacology, Leiden UniversityLeiden, the Netherlands
- Department of Medical Informatics, Erasmus Medical CenterRotterdam, the Netherlands
- Department of Epidemiology, Erasmus Medical CenterRotterdam, the Netherlands
- Clinical Pharmacology and Discovery Medicine, GlaxoSmithKlineUxbridge, UK
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Yamasaki K, Yatera K, Kawanaml T, Suzuki Y, Choujin Y, Akata K, Ogoshi T, Tokuyama S, Nagata S, Inoue N, Noguchi S, Nishida C, Orihashi T, Yoshida Y, Kawanami Y, Taura Y, Ishimoto H, Kawajiri T, Obata H, Awaya Y, Yoshii C, Mukae H. [Efficacy and safety of moxifloxacin in patients with nursing and healthcare-associated pneumonia]. Jpn J Antibiot 2013; 66:283-292. [PMID: 24527518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Moxifloxacin (MFLX) is a respiratory quinolone, and is effective against not only Gram-positive and negative bacteria but also anaerobes. There has been no prospective studies evaluating the efficacy and safety of MFLX in patients with nursing and healthcare-associated pneumonia (NHCAP). Therefore, we assessed the efficacy and safety of MFLX in patients with NHCAP. NHCAP patients with mild and moderate severity assessed by the A-DROP system in community-acquired pneumonia guideline proposed by Japan Respiratory Society visited our hospitals from April 2011 to March 2012. Clinical symptoms, chest X-ray films and/or computed tomography, peripheral white and red blood cell and platelet counts, serum CRP, AST, ALT, BUN, creatinine were evaluated. Forty patients were eventually evaluated, and average age was 74.1 years old, male/female were 21/19, 92.5% (37/40) of them had one or more comorbidities. Median duration of MFLX administration was 7.1 days (4-15 days). The efficacy of MFLX in all patients was 87.5% (35/40). The efficacies in each age group were 87.9% (aged over 65 years old), 85.7% (aged under 64 years old), and in each pneumonia severity group by the A-DROP system were 91.7% (mild), 85.7% (moderate). Diarrhea and swelling of the breast were observed in one patient (2.5%) after starting MFLX administration. Mild elevated transaminases were observed in three patients (7.5%), and mild renal dysfunction was observed in two patients (5.0%). All abnormally increased levels of transaminases and serum creatinine were recovered after a cessation of MFLX. MFLX is effective and safe in patients with NHCAP.
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Affiliation(s)
- Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Toshinori Kawanaml
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Yu Suzuki
- Department of Respiratory Medicine, Kokura Memorial Hospital
| | - Yasuo Choujin
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Kentarou Akata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Takaaki Ogoshi
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Shuya Nagata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Naomasa Inoue
- Department of Internal Medicine, Kyushu Rosai Hospital
| | - Shingo Noguchi
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Chinatsu Nishida
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Takeshi Orihashi
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | - Yugo Yoshida
- Department of Internal Medicine, Kitakyushu Municipal Yahata Hospital
| | - Yukiko Kawanami
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | - Yuusuke Taura
- Department of Respiratory Medicine, Kokura Memorial Hospital
| | - Hiroshi Ishimoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
| | | | - Hideto Obata
- Department of Respiratory Medicine, Yamaguchi-ken Saiseikai Shimonoseki General Hospital
| | - Yukikazu Awaya
- Department of Internal Medicine, Kitakyushu Municipal Yahata Hospital
| | - Chiharu Yoshii
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan
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7
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Chen F, Zheng N, Wang Y, Wen JL, Tu WF, Du YQ, Lin JM. Sequential intravenous/oral moxifloxacin monotherapy for complicated skin and skin structure infections: a meta-analysis of randomised controlled trials. Int J Clin Pract 2013; 67:834-42. [PMID: 23952463 DOI: 10.1111/ijcp.12174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 03/13/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The presumed superiority of moxifloxacin for the treatment of complicated skin and skin structure infections (cSSSIs) is based on laboratory data, but has not yet been established on clinical grounds. The aim of this meta-analysis was to evaluate the efficacy and safety of sequential intravenous (i.v.)/oral (p.o.) moxifloxacin monotherapy for the treatment of cSSSIs. METHODS Randomised controlled trials (RCTs) published prior to November 2012 were systematically retrieved from PubMed, MEDLINE, EMBASE, ScienceDirect, ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials. Finally, a meta-analysis of all RCTs eligible for inclusion criteria was performed. RESULTS Three studies that enrolled 2255 patients were included in the meta-analysis. There were no statistically significant differences between patients given moxifloxacin and those given other antibiotics with regard to clinical success rate [1667 patients, odds ratio (OR) = 0.83, 95% confidence interval (CI) 0.63 to 1.09, p = 0.18], bacteriological success rate (bacteriological success rates: 1502 patients, OR = 0.90, 95% CI 0.68-1.18, p = 0.45) or mortality (2207 patients, OR = 1.96, 95% CI 0.79-4.88, p = 0.15). Significantly, more overall adverse events (AEs) were associated with the use of moxifloxacin than with other antibiotics (2207 patients, OR = 1.21, 95%CI 1.00-1.45, p = 0.04). However, there was no statistically significant difference in the occurrence of drug-related AEs, serious AEs or serious drug-related AEs between patients given moxifloxacin and those given other antibiotics. CONCLUSION Sequential i.v./p.o. moxifloxacin monotherapy is an effective and relatively safe option for the treatment of cSSSIs. Other benefits of moxifloxacin may make it a more viable option compared with the currently used regimens.
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Affiliation(s)
- F Chen
- Department of Pharmacy, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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8
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Chao CM, Lin SH, Lai CC. Abdominal wall hematoma and hemoperitoneum in an individual with concomitant use of warfarin and moxifloxacin. J Am Geriatr Soc 2013; 61:1432-3. [PMID: 23937503 DOI: 10.1111/jgs.12375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
We report the case of a 73 year old patient with a COPD. A severe exazerbation was treated with glucocorticoids and Quinolones. A few days later both ankles were tender and painful. Ultrasound examination showed bilateral Achilles tendon ruptures. Diagnostics, etiology and therapeutic options are discussed.
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Affiliation(s)
- Stefanie Schuster
- Fachbereich Allgemeine Innere Medizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
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11
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Wang SH, Xie YC, Jiang B, Zhang JY, Qu Y, Zhao Y, Li Y, Qiao SS, Xu CL. [Fluoroquinolone associated myasthenia gravis exacerbation: clinical analysis of 9 cases]. Zhonghua Yi Xue Za Zhi 2013; 93:1283-1286. [PMID: 24029473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To explore the characteristics of acute exacerbations of myasthenia gravis after fluoroquinolone exposure. METHODS Gender, age, prior type, absolute score, concurrent disease, precipitated disease, use of antibiotic, onset/symptom/degree of exacerbation, therapeutic measures and prognosis at Month 1 were retrospectively analyzed for 9 patients after fluoroquinolone systemic exposure. RESULTS Ciprofloxacin (n = 4), levofloxacin (n = 1) and moxifloxacin (n = 4) exposure resulted in myasthenia gravis exacerbation. Myasthenia gravis exacerbations developed at 15 minutes to 4 days post-exposure. And the clinical scores of quantitative myasthenia gravis (QMG) increased by an average of 10. The main syndromes included dyspnea, diplopia, ptosis and dysphagia. All patients improved upon the withdrawal of fluoroquinolone in conjunctions with other interventions. CONCLUSION Fluoroquinolone exposure may result in myasthenia gravis exacerbations in patients with underlying diseases. Healthcare professionals should be aware of this serious drug-disease association.
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Affiliation(s)
- Shu-hui Wang
- Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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Abstract
An elderly diabetic male with pneumonia presented with multiorgan failure. He developed hypoglycemic episodes with moxifloxacin that responded only to withdrawal of moxifloxacin.
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Affiliation(s)
- Dinesh Kumar Singal
- Department of Gastroenterology, Pushpawati Singhania Research Institute for Liver, Renal & Digestive Diseases, Press Enclave Marg, Sheikh Sarai, Phase II, New Delhi, India
| | - Amit Mittal
- Department of Gastroenterology, Pushpawati Singhania Research Institute for Liver, Renal & Digestive Diseases, Press Enclave Marg, Sheikh Sarai, Phase II, New Delhi, India
| | - Anukalp Prakash
- Department of Gastroenterology, Pushpawati Singhania Research Institute for Liver, Renal & Digestive Diseases, Press Enclave Marg, Sheikh Sarai, Phase II, New Delhi, India
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Abstract
A 39-year-old woman with 1 day of oral petechiae, leg ecchymoses and epistaxis was found to have isolated thrombocytopenia. She had recently completed a 10-day course of moxifloxacin for an upper respiratory infection. On further questioning, she had developed thrombocytopenia 2 years earlier after a treatment course with moxifloxacin. After ruling out other causes, drug-induced immune thrombocytopenia due to moxifloxacin was diagnosed. Her platelets returned to normal range 15 days after finishing the medication.
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Affiliation(s)
- Timothy J Coker
- Ehrling Bergquist Family Medicine Residency, Offutt AFB, Nebraska, USA.
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Parekh JG, Newsom TH, Nielsen S. Safety of besifloxacin ophthalmic suspension 0.6% in cataract surgery patients. J Cataract Refract Surg 2013; 38:1864-7. [PMID: 22999608 DOI: 10.1016/j.jcrs.2012.08.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Indexed: 11/18/2022]
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Cheng L, Fang Y, Li JQ. [One case of torsades de pointes with Aase's syndrome induced by moxifloxacin]. Zhonghua Xin Xue Guan Bing Za Zhi 2013; 41:69-70. [PMID: 23651972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Diacon AH, Dawson R, von Groote-Bidlingmaier F, Symons G, Venter A, Donald PR, van Niekerk C, Everitt D, Winter H, Becker P, Mendel CM, Spigelman MK. 14-day bactericidal activity of PA-824, bedaquiline, pyrazinamide, and moxifloxacin combinations: a randomised trial. Lancet 2012; 380:986-93. [PMID: 22828481 DOI: 10.1016/s0140-6736(12)61080-0] [Citation(s) in RCA: 297] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND New drugs, but also shorter, better-tolerated regimens are needed to tackle the high global burden of tuberculosis complicated by drug resistance and retroviral disease. We investigated new multiple-agent combinations over the first 14 days of treatment to assess their suitability for future development. METHODS In this prospective, randomised, early bactericidal activity (EBA) study, treatment-naive, drug-susceptible patients with uncomplicated pulmonary tuberculosis were admitted to hospitals in Cape Town, South Africa, between Oct 7, 2010, and Aug 19, 2011. Patients were randomised centrally by computer-generated randomisation sequence to receive bedaquiline, bedaquiline-pyrazinamide, PA-824-pyrazinamide, bedaquiline-PA-824, PA-824-moxifloxacin-pyrazinamide, or unmasked standard antituberculosis treatment as positive control. The primary outcome was the 14-day EBA assessed in a central laboratory from the daily fall in colony forming units (CFU) of M tuberculosis per mL of sputum in daily overnight sputum collections. Bilinear regression curves were fitted for each group separately and groups compared with ANOVA for ranks, followed by pair-wise comparisons adjusted for multiplicity. Clinical staff were partially masked but laboratory personnel were fully masked. This study is registered, NCT01215851. FINDINGS The mean 14-day EBA of PA-824-moxifloxacin-pyrazinamide (n=13; 0·233 [SD 0·128]) was significantly higher than that of bedaquiline (14; 0·061 [0·068]), bedaquiline-pyrazinamide (15; 0·131 [0·102]), bedaquiline-PA-824 (14; 0·114 [0·050]), but not PA-824-pyrazinamide (14; 0·154 [0·040]), and comparable with that of standard treatment (ten; 0·140 [0·094]). Treatments were well tolerated and appeared safe. One patient on PA-824-moxifloxacin-pyrazinamide was withdrawn because of corrected QT interval changes exceeding criteria prespecified in the protocol. INTERPRETATION PA-824-moxifloxacin-pyrazinamide is potentially suitable for treating drug-sensitive and multidrug-resistant tuberculosis. Multiagent EBA studies can contribute to reducing the time needed to develop new antituberculosis regimens. FUNDING The Global Alliance for TB Drug Development (TB Alliance).
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Affiliation(s)
- Andreas H Diacon
- Division of Physiology, Department of Medical Biochemistry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Kori S, Kellerman DJ, Voloshko P, Haugen G. Effects of a supratherapeutic dose of investigational orally inhaled dihydroergotamine (MAP0004) on QT interval: a randomized, double-blind, active- and placebo-controlled crossover study in healthy volunteers. Clin Ther 2012; 34:1920-8. [PMID: 22917853 DOI: 10.1016/j.clinthera.2012.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 07/31/2012] [Accepted: 08/01/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND MAP0004 is an orally inhaled investigational drug containing dihydroergotamine (DHE). Although DHE has been used for 60 years with no reported cardiac arrhythmias, a thorough QT study had not previously been performed with DHE. OBJECTIVE The objective of this study was to assess the effects of MAP0004 on the QT interval as required for regulatory approval of a new product. METHODS This randomized, double-blind, placebo-controlled, 3-period crossover study enrolled healthy volunteers. Subjects were assigned to receive, in randomized sequence, MAP0004 at a supratherapeutic dose (3-fold the clinically effective dose) (3.0 mg), moxifloxacin 400 mg, or inactive vehicle, each administered with 1 placebo capsule. Triplicate ECGs were performed continuously at baseline (day 0), before dosing, and over 24 hours after dosing in each treatment period. The effect on the QT interval was assessed using the Fridericia (QTcF) and individualized (QTcI) correction formulas. RESULTS Fifty-four healthy adults (20 men, 34 women; mean age, 28 years) completed the trial and had measurable plasma levels of DHE after MAP0004 administration. The largest observed mean difference in QTcI between MAP0004 and placebo was 0.08 msec, and the largest 1-sided 95% upper confidence bound was 2.24 msec, both at 30 minutes after dosing. In contrast, moxifloxacin increased the mean QTcI between 9.57 and 11.28 msec relative to placebo, with a 1-sided lower 95% CL between 7.23 and 8.96 msec, confirming that the assay sensitivity was sufficient to detect MAP0004-related effects. Nausea (27.8%) was common following MAP0004 administration but apparently did not influence the QTc interval. CONCLUSIONS A supratherapeutic dose of MAP0004 was not associated with prolonged QTc intervals. At the proposed clinical dose (1.0 mg), MAP0004 is unlikely to affect the QT interval. MAP0004 and its primary metabolite showed no evidence for prolongation of the QTc interval in healthy subjects according to the criteria required from regulatory agencies. ClinicalTrials.gov identifier: NCT01191723.
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Affiliation(s)
- Shashidhar Kori
- MAP Pharmaceuticals, Inc, Mountain View, California 94043, USA
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19
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Yew KL, Lee WC. Moxifloxacin-warfarin interaction. Med J Malaysia 2012; 67:420-421. [PMID: 23082454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Kuan Leong Yew
- Cardiology Department, Sarawak General Hospital, 94300 Kota Samarahan, Sarawak, Malaysia.
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[Moxifloxacin (Kanavig), ophthalmic administration]. J Pharm Belg 2012;:41-2. [PMID: 22978015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Belfort R, Gabriel L, Martins Bispo PJ, Muccioli C, Zacharias Serapicos PC, Clark L, Bell B, Bartell J, Stroman DW, Höfling-Lima AL. Safety and efficacy of moxifloxacin-dexamethasone eyedrops as treatment for bacterial ocular infection associated with bacterial blepharitis. Adv Ther 2012; 29:416-26. [PMID: 22562783 DOI: 10.1007/s12325-012-0018-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Treatments that offer two medications in a fixed combination have the potential to offer efficacious and safe treatment with advantages such as a regimen that is simpler than administering two separate solutions. This study evaluated the safety and efficacy of fixed-combination versus concomitant moxifloxacin 0.5% and dexamethasone 0.1% ocular solutions for the treatment of bacterial ocular inflammation and infection. METHODS The clinical study design was a randomized, double-masked, active-controlled, parallel-group trial of 102 subjects with bacterial blepharitis in which two patients also had bacterial conjunctivitis. All subjects received two bottles of study medication: either a fixed combination of moxifloxacin 0.5%/dexamethasone 0.1% ophthalmic solution and placebo eye drops (fixed-dose group), or moxifloxacin 0.5% ophthalmic solution and dexamethasone 0.1% (concomitant group). One drop of each study medication was instilled bilaterally four times per day for 7 days. Clinical resolution, signs, symptoms, and safety were assessed. Microbiological specimens were collected from the eyelid margin and conjunctivae of each eye from each patient at the time of enrollment and at the exit visit. RESULTS Clinical resolution occurred similarly in both groups (81.6% of eyes, fixed-dose group; 82.3% of eyes, concomitant group). Moreover, the microbiological efficacy of the treatment was also similar for both the fixed-dose group (84%) and the concomitant group (83%). Ocular symptoms and signs improved over time, with no significant differences between groups after 7 days of treatment, except the fixed-dose group had significantly more eyes with clinical resolution in eyelid erythema (100%, n = 98/98, fixed-dose group; 92.7%, n = 89/96, concomitant group; P = 0.0194) and eyelid scaling/crusting (98%, n = 96/98, fixed-dose group; 89.6%; n = 86/96 eyes, concomitant group; P = 0.0337). Both regimens were safe and well tolerated. CONCLUSION The fixed-dose combination of moxifloxacin, 0.5% and dexamethasone, 0.1% was therapeutically equivalent and as well tolerated as the concomitant dosage.
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Affiliation(s)
- Rubens Belfort
- Vision Institute, Federal University of São Paulo, Rua Botucatu 822, 04023-062, São Paulo, Brazil.
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Sy A, Srinivasan M, Mascarenhas J, Lalitha P, Rajaraman R, Ravindran M, Oldenburg CE, Ray KJ, Glidden D, Zegans ME, McLeod SD, Lietman TM, Acharya NR. Pseudomonas aeruginosa keratitis: outcomes and response to corticosteroid treatment. Invest Ophthalmol Vis Sci 2012; 53:267-72. [PMID: 22159005 PMCID: PMC3292362 DOI: 10.1167/iovs.11-7840] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/19/2011] [Accepted: 11/22/2011] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare the clinical course and effect of adjunctive corticosteroid therapy in Pseudomonas aeruginosa with those of all other strains of bacterial keratitis. METHODS Subanalyses were performed on data collected in the Steroids for Corneal Ulcers Trial (SCUT), a large randomized controlled trial in which patients were treated with moxifloxacin and were randomly assigned to 1 of 2 adjunctive treatment arms: corticosteroid or placebo (4 times a day with subsequent reduction). Multivariate analysis was used to determine the effect of predictors, organism, and treatment on outcomes, 3-month best-spectacle-corrected visual acuity (BSCVA), and infiltrate/scar size. The incidence of adverse events over a 3-month follow-up period was compared using Fisher's exact test. RESULTS SCUT enrolled 500 patients. One hundred ten patients had P. aeruginosa ulcers; 99 of 110 (90%) enrolled patients returned for follow-up at 3 months. Patients with P. aeruginosa ulcers had significantly worse visual acuities than patients with other bacterial ulcers (P = 0.001) but showed significantly more improvement in 3-month BSCVA than those with other bacterial ulcers, adjusting for baseline characteristics (-0.14 logMAR; 95% confidence interval, -0.23 to -0.04; P = 0.004). There was no significant difference in adverse events between P. aeruginosa and other bacterial ulcers. There were no significant differences in BSCVA (P = 0.69), infiltrate/scar size (P = 0.17), and incidence of adverse events between patients with P. aeruginosa ulcers treated with adjunctive corticosteroids and patients given placebo. CONCLUSIONS Although P. aeruginosa corneal ulcers have a more severe presentation, they appear to respond better to treatment than other bacterial ulcers. The authors did not find a significant benefit with corticosteroid treatment, but they also did not find any increase in adverse events. (ClinicalTrials.gov number, NCT00324168.).
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Affiliation(s)
- Aileen Sy
- From the F. I. Proctor Foundation and
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- the Departments of Epidemiology and Biostatistics and
| | - Michael E. Zegans
- the Departments of Surgery (Ophthalmology) and
- Microbiology and Immunology, Dartmouth Medical School, Lebanon, New Hampshire
| | - Stephen D. McLeod
- From the F. I. Proctor Foundation and
- Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Thomas M. Lietman
- From the F. I. Proctor Foundation and
- the Departments of Epidemiology and Biostatistics and
- Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Nisha R. Acharya
- From the F. I. Proctor Foundation and
- Ophthalmology, University of California, San Francisco, San Francisco, California
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Terada M, Izumi K, Ohki E, Yamagishi Y, Mikamo H. Antimicrobial efficacies of several antibiotics against uterine cervicitis caused by Mycoplasma genitalium. J Infect Chemother 2011; 18:313-7. [PMID: 22020630 DOI: 10.1007/s10156-011-0329-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 10/06/2011] [Indexed: 11/30/2022]
Abstract
Mycoplasma genitalium has been shown to be one of the pathogens responsible for uterine cervicitis by many studies. However, there are no clinical recommendations for treating M. genitalium-positive uterine cervicitis. Our study retrospectively investigated the antimicrobial efficacies of several antibiotics against uterine cervicitis caused by M. genitalium. We studied a total of 257 women with M. genitalium-positive uterine cervicitis, except for those with chlamydial and gonococcal infections, who were treated with one of the following antibacterial therapies: azithromycin extended release formulation (AZM-SR) 2 g single dose, azithromycin (AZM) 1 g single dose, clarithromycin (CAM) 400 mg/day for 7 days, CAM 400 mg/day for 14 days, moxifloxacin (MFLX) 400 mg/day for 7 days, MFLX 400 mg/day for 14 days, levofloxacin (LVFX) 500 mg/day for 7 days, LVFX 500 mg/day for 14 days, sitafloxacin (STFX) 200 mg/day for 7 days, and STFX 200 mg/day for 14 days. A PCR-based assay was performed to evaluate the microbiological efficacy of eradication in these patients. M. genitalium was eradicated from the uterine cervix in 19 of the 21 (90.5%) patients treated with AZM-SR 2 g single dose, in 38 of the 42 (90.5%) patients treated with MFLX 400 mg/day for 7 days, in 42 of the 42 (100%) patients treated with MFLX 400 mg/day for 14 days, and in 12 of the 13 (92.3%) patients treated with STFX 200 mg/day for 14 days. In conclusion, AZM-SR 2 g single dose, MFLX 400 mg/day for 14 days, and STFX 200 mg/day for 14 days would each be an effective treatment for M. genitalium infection.
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Affiliation(s)
- Michinori Terada
- Department of Infection Control and Prevention, Aichi Medical University, 21 Karimata, Yazako, Nagakute-cho, Aichi-gun, Aichi 480-1195, Japan.
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Intravenous moxifloxacin. Even more harmful than the oral form. Prescrire Int 2011; 20:151. [PMID: 21678703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Lee J, Lee CH, Kim DK, Yoon HI, Kim JY, Lee SM, Yang SC, Lee JH, Yoo CG, Lee CT, Chung HS, Kim YW, Han SK, Yim JJ. Retrospective comparison of levofloxacin and moxifloxacin on multidrug-resistant tuberculosis treatment outcomes. Korean J Intern Med 2011; 26:153-9. [PMID: 21716591 PMCID: PMC3110847 DOI: 10.3904/kjim.2011.26.2.153] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 01/03/2011] [Accepted: 02/16/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS To compare the effect of levofloxacin and moxifloxacin on treatment outcomes among patients with multidrug-resistant tuberculosis (MDR-TB). METHODS A retrospective analysis of 171 patients with MDR-TB receiving either levofloxacin or moxifloxacin was performed. Treatment responses were categorized into treatment success (cured and treatment completed) or adverse treatment outcome (death, failure, and relapsed). RESULTS The median age of the patients was 42.0 years. Approximately 56% of the patients were male. Seventeen patients had extensively drug-resistant tuberculosis, and 20 had a surgical resection. A total of 123 patients (71.9%) received levofloxacin for a median 594 days, and 48 patients (28.1%) received moxifloxacin for a median 673 days. Other baseline demographic, clinical, and radiographic characteristics were similar between the two groups. The moxifloxacin group had a significantly higher number of resistant drugs (p < 0.001) and a higher incidence of resistance to ofloxacin (p = 0.005) in the drug sensitivity test. The treatment success rate was 78.9% in the levofloxacin group and 83.3% in the moxifloxacin group (p = 0.42). Adverse reactions occurred at similar rates in the groups (p = 0.44). Patients in the moxifloxacin group were not more likely to have treatment success than those in the levofloxacin group (adjusted odds ratio, 0.76; 95% confidence interval, 0.24 to 2.43; p = 0.65). CONCLUSIONS Both levofloxacin and moxifloxacin showed equivalent efficacy for treating MDR-TB.
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Affiliation(s)
- Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Yeol Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Chul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Soon Chung
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
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Farhoumand AD, Trombert V, Eusebio J. [Practical ECG problems in the elderly patient. Case number 16. Moxifloxacin-associated QT interval prolongation]. Rev Med Suisse 2011; 7:624-625. [PMID: 21510347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Magden ER, Weiner CM, Gilliland JC, DeGroote MA, Lenaerts AJ, Kendall LV. Torticollis in mice intravenously infected with Mycobacterium tuberculosis. J Am Assoc Lab Anim Sci 2011; 50:244-7. [PMID: 21439219 PMCID: PMC3061426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 09/17/2010] [Accepted: 09/30/2010] [Indexed: 05/30/2023]
Abstract
Female BALB/cAnNCrl (n = 170; age, 6 to 9 wk) mice were infected by intravenous inoculation of 5 × 10(6) cfu Mycobacterium tuberculosis strain Erdman (ATCC 35801). Between day 52 and 5 mo after infection, 10 of the 170 mice infected according to this protocol developed torticollis, including mice in treatment groups that received combination antibiotic therapy of rifampin-pyrazinamide or moxifloxacin-rifampin-pyrazinamide. Torticollis did not develop in mice receiving isoniazid- rifampin-pyrazinamide therapy, nor was it present in the cohort of aerogenically infected mice. Affected mice were euthanized, and complete necropsy evaluation was performed on 4 mice. Gross necropsy evaluation revealed typical tuberculosis lesions in lungs of infected mice. Histologic evaluation of tissues revealed granulomatous otitis media with intralesional acid-fast bacilli consistent with Mycobacterium tuberculosis. These cases represent an unusual finding specific to the intravenous mouse model of Mycobacterium tuberculosis and may represent a model of a similar condition in humans that is known as tuberculous otitis media.
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Affiliation(s)
- Elizabeth R Magden
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Cristina M Weiner
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Janet C Gilliland
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Mary Ann DeGroote
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Anne J Lenaerts
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Lon V Kendall
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Darpo B, Fossa AA, Couderc JP, Zhou M, Schreyer A, Ticktin M, Zapesochny A. Improving the precision of QT measurements. Cardiol J 2011; 18:401-410. [PMID: 21769821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Accurate and precise QT interval measurement is very important for both regulatory and drug developmental decision making. These measurements are often made using a manual or semi-automated technique, and the associated variability necessitates sample sizes of around 50 to 70 subjects in thorough QT/QTc studies. The purpose of this study was to compare the reproducibility and precision of a semi-automated (SA) method and a high-precision (HPQT) technique for ECG extraction and QT interval measurement on two thorough QT/QTc (TQT) studies conducted in compliance with ICH E14. METHODS Data from 35 healthy subjects from two different crossover TQT studies on treatment with placebo and moxifloxacin was analyzed. Both methods examined the RR and QT intervals measured in lead II or the lead with the highest quality T-wave on a single beat basis using the QT algorithm included in the COMPAS software package. ECGs were measured at a protocol-specific timepoint. RESULTS The effect of moxifloxacin on the QTc interval was highly reproducible in the two studies, and assay sensitivity was met with both methods. Pairwise comparison of QTcF values between methods demonstrated high agreement with no bias, small mean differences (below 1.5 ms) and narrow limits of agreement. HPQT improved the precision of the QTc measurement by 31% in Study I (standard deviation of DQTcF: SA 8.9 ms; HPQT 6.3 ms) and by 15% in Study II (SD: SA 9.7 ms; HPQT 8.3 ms). CONCLUSIONS The HPQT QT measurement technique detected the effect induced by moxifloxacin with the same accuracy as SA techniques, and with clearly improved precision. More precise QTc measurement has important implications in terms of lowering the likelihood of false positive results and/or reducing the sample size in TQT studies, as well as improving the utility of QT assessment in early clinical development.
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Affiliation(s)
- Borje Darpo
- iCardiac Technologies, 150 Allen Creek Rd., Rochester, NY 14618, USA
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Baas T, Gräfe K, Khawaja A, Dössel O. Investigation of parameters highlighting drug induced small changes of the T-wave's morphology for drug safety studies. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2011:3796-3799. [PMID: 22255166 DOI: 10.1109/iembs.2011.6090769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In guideline E14, the American Food and Drug Administration (FDA) requests for clinical studies to investigate the prolongation of the heart rate corrected QT-interval (QTc) of the ECG. As drug induced QT-prolongation can be caused by changes in the repolarisation of the ventricles, it is so far a thorough ECG biomarker of risk for ventricular tachyarrhythmias and Torsade de Pointes (TdP). Ventricular repolarisation changes not only change QT but also influence the morphology of the T-wave. In a (400 mg single dose) Moxifloxacin positive control study both, QTc and several descriptors describing the T-wave morphology have been measured. Moxifloxacin is changing two shape dependent descriptors significantly (P<0.05) about 3 to 4 hours after a 400 mg oral single dose of Moxifloxacin.
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Affiliation(s)
- Tobias Baas
- Karlsruhe Institute of Technology, Institute of Biomedical Engineering, 76131 Karlsruhe,
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Wedam EF, Haigney MC. The thorough QT study: let's be precise. Cardiol J 2011; 18:341-342. [PMID: 21769813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
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Zhou B, Jiang X, Zhai L, Xiao S, Wang J, Xiao G, Ruan B, Liang C, Ye Q, Hu B, Wang H. Moxifloxacin in the treatment of acute bacterial rhinosinusitis: results of a multicenter, non-interventional study. Acta Otolaryngol 2010; 130:1058-64. [PMID: 20235900 DOI: 10.3109/00016481003629036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Moxifloxacin was generally well tolerated and highly effective in the treatment of acute bacterial rhinosinusitis (ABS). The incidence of adverse events (AEs) and adverse drug reactions (ADRs) was low. The effectiveness, safety, and tolerability information collected in this study confirm the clinical safety profile of moxifloxacin and its benefit as a treatment option for ABS. OBJECTIVE To assess the effectiveness, safety, and tolerability of moxifloxacin under daily life treatment conditions in patients with ABS. METHODS The study was carried out in China between September 2005 and May 2007. Patients with ABS were treated with moxifloxacin tablets 400 mg once daily for a duration that was left to the physician's discretion. Data were collected on demography, diagnosis of infection, pretreatment, concomitant diseases and medications, moxifloxacin therapy, course of symptoms during investigations, and final assessment of therapy. RESULTS In all, 578 patients with ABS treated with moxifloxacin were valid for effectiveness analysis. An improvement was observed in 98.8% (n = 571/578) of the patients. Cure was documented in 89.4% (n = 517/578) of the patients. The physicians' overall tolerability rating was 'very good' or 'good' in 92.9% (n = 537/578) of patients. The incidence rates of AEs and ADRs were 1.5% (n = 10/681) and 0.6% (n = 4/681), respectively. No serious AE was reported.
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Affiliation(s)
- Bing Zhou
- ENT Department, Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key laboratory of Otolaryngology-Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
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Stass H, Delesen H, Kubitza D, Mai I, Bauer S, Roots I. Moxifloxacin does not alter ciclosporin pharmacokinetics in transplant patients: a multiple-dose, uncontrolled, single-centre study. Clin Drug Investig 2010; 30:279-87. [PMID: 20384384 DOI: 10.1007/bf03256904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Moxifloxacin has a broad antibacterial spectrum and rapid bactericidal activity, and is thus a good option for the treatment of bacterial infections in patients who have undergone organ or bone marrow transplantation. Transplant patients also receive immunosuppressant therapy such as ciclosporin. OBJECTIVE The primary objective of this study was to assess the steady-state pharmacokinetics of ciclosporin with and without concomitant treatment with moxifloxacin in transplant recipients. A secondary objective was to determine the safety and tolerability of the combined treatment. METHODS Patients (n = 9) with stable graft function after bone marrow or renal transplantation and who were already receiving ciclosporin therapy were enrolled into the study. The patients were given ciclosporin (Sandimmun Optoral) capsules twice daily (total daily dosage 150-380 mg/day) throughout the study period. Moxifloxacin (Avolox) tablets 400 mg once daily were given on days 2-8 inclusive. The primary outcome measure was the change in ciclosporin pharmacokinetics on coadministration with moxifloxacin. Secondary outcomes were the steady-state pharmacokinetics of moxifloxacin and ciclosporin plus its metabolites in patients receiving moxifloxacin and ciclosporin concomitantly. Moxifloxacin pharmacokinetic parameters in the presence of ciclosporin were compared with previously published pharmacokinetic data for moxifloxacin in healthy individuals. RESULTS No significant changes occurred in the concentration-time curves of ciclosporin and its metabolites following combination therapy with moxifloxacin. The geometric means of whole blood concentrations of ciclosporin and ciclosporin plus its metabolites on day 1 were similar to those on day 8 following combined administration of ciclosporin and moxifloxacin for 7 days. The ratio of combination treatment to monotherapy for ciclosporin was 1.01 (90% CI 0.91, 1.11) for the area under the blood concentration-time curve from time zero to 12 hours at steady state (AUC(12,ss)) and 0.96 (90% CI 0.88, 1.04) for the maximum steady-state blood drug concentration (C(max,ss)). For ciclosporin plus its metabolites the ratio was 1.07 (90% CI 0.99, 1.17) for AUC(12,ss) and 1.03 (90% CI 0.98, 1.09) for C(max,ss). The pharmacokinetic parameters for moxifloxacin were unaffected by the presence of ciclosporin. CONCLUSIONS Concomitant administration of moxifloxacin does not alter the pharmacokinetic parameters of ciclosporin or ciclosporin plus its metabolites in immunosuppressed patients. Therefore, no dose adjustments or additional drug monitoring are required when ciclosporin is coadministered with moxifloxacin.
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Affiliation(s)
- Heino Stass
- Bayer HealthCare AG, Clinical Pharmacology, Wuppertal, Germany.
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Wang JY, Wang JT, Tsai TH, Hsu CL, Yu CJ, Hsueh PR, Lee LN, Yang PC. Adding moxifloxacin is associated with a shorter time to culture conversion in pulmonary tuberculosis. Int J Tuberc Lung Dis 2010; 14:65-71. [PMID: 20003697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE To investigate whether adding moxifloxacin (MXF) to the standard anti-tuberculosis regimen can shorten the time to sputum culture conversion in pulmonary tuberculosis (PTB). METHODS Adults with culture-positive PTB were divided into two treatment groups by their choice: standard regimen alone (HERZ group) and standard regimen plus daily 400 mg MXF in the first 2 months (MXF group). Sputum samples were collected thrice weekly in the first 8 weeks. The propensity score was calculated to estimate the conditional probability of entering the MXF group. Factors influencing time to culture conversion were investigated using Cox proportional hazards regression analysis stratified by propensity score. RESULTS Sixty-two patients were enrolled in the MXF group and 88 in the HERZ group; respectively 51 and 72 completed the study. The regimen was modified before culture conversion in respectively 6 (12%) and 12 (16%; P = 0.47) patients, due to adverse effects. The time to culture conversion was shorter in the MXF group (HR 2.1, 95%CI 1.4-3.2). The culture conversion rate after 6 weeks of treatment was respectively 82% and 61% (P = 0.011, <0.05/4, calculated using the modified Bonferroni method). CONCLUSIONS Adding MXF to the standard anti-tuberculosis regimen in the first 2 months was associated with a shorter time to culture conversion, a higher 6-week culture conversion rate and reduced transmission of tuberculosis.
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Affiliation(s)
- J-Y Wang
- Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Weaver CH, Huddleston HM, Kingsley MM, Wolverton SE. Moxifloxacin-induced drug hypersensitivity syndrome with features of toxic epidermal necrolysis. J Drugs Dermatol 2009; 8:1031-1033. [PMID: 19894372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Moxifloxacin was recently reported to induce combined features of drug hypersensitivity syndrome (DHS) and toxic epidermal necrolysis (TEN). A simultaneous presentation of these two potentially life-threatening cutaneous drug eruptions with systemic features in the same patient is considered rare since they are probably induced by two separate mechanisms. There is only one previously reported case in which moxifloxacin was implicated in the induction of these combined drug hypersensitivity processes. This article presents the case of a 44-year-old Asian male who developed features of both TEN and DHS approximately one week after initial ingestion of moxifloxacin.
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Affiliation(s)
- Chad H Weaver
- Indiana University Department of Dermatology, Indianapolis, IN, USA
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Moxifloxacin: new indication. Do not use in gynaecological infections or other conditions. Prescrire Int 2009; 18:207. [PMID: 19882788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In pelvic inflammatory disease, fluoroquinolones are not first-line drugs and moxifloxacin is the worst of these drugs.
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Moxifloxacin: new indication. Inadequate restriction of indications in ENT and respiratory infections. Prescrire Int 2009; 18:206. [PMID: 19882787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Moxifloxacin carries an increased risk of fatal adverse effects and yet is no more effective than other fluoroquinolones. It should simply be taken off the market.
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Hulhoven R, Rosillon D, Bridson WE, Meeus MA, Salas E, Stockis A. Effect of levetiracetam on cardiac repolarization in healthy subjects: a single-dose, randomized, placebo- and active-controlled, four-way crossover study. Clin Ther 2009; 30:260-70. [PMID: 18343264 DOI: 10.1016/j.clinthera.2008.02.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nonantiarrhythmic drugs may have the potential to prolong the QT interval, leading to potentially fatal ventricular tachycardias, including torsades de pointes. OBJECTIVE This study evaluated the potential of the newer-generation, multiple-action antiepileptic drug levetiracetam, which binds to the synaptic vesicle protein SV2A, to affect cardiac repolarization, as detected by prolongation of the QT/corrected QT (QTc) interval. METHODS This was a single-dose, randomized, placebo- and active-controlled, 4-way crossover study in healthy subjects. Subjects were randomly allocated to 1 of 4 different administration sequences. Each sequence included 3 double-blind treatments (levetirace-tam 1000 mg, levetiracetam 5000 mg, and placebo) and 1 open-label treatment (moxifloxacin 400 mg). Triplicate electrocardiograms (ECGs) were obtained at baseline and at various time points over 24 hours after each treatment using continuous Holter monitoring. ECGs were read centrally in a blinded manner. Blood samples for the determination of plasma concentrations of levetiracetam and moxifloxacin were collected before dosing and at 0.5, 1, 1.5, 2, 4, 6, 12, and 24 hours after dosing, within 5 minutes after the ECG recordings. The QT interval was corrected for heart rate using a sex- and study-specific correction (QTc(ss)) as the primary outcome measure and Fridericia's correction (QTc(F))as a secondary outcome measure. The primary analysis was performed on the time-matched, baseline-subtracted QTc(ss) (DeltaQTc(ss)). The maximum DeltaQTc(ss) difference between each active treatment and placebo (DeltaDeltaTc(ss)) was derived from a mixed-effect analysis of variance. Clinical laboratory tests, standard 12-lead ECGs, and vital signs were monitored at regular intervals. Spontaneously reported adverse events were recorded throughout the study. RESULTS Fifty-two healthy, nonsmoking subjects (26 men, 26 women; 37 white, 9 black, 3 Hispanic, and 3 Asian/Pacific Islander) with a mean (SD) age of 28.4 (7.5) years (range, 18-45 years) and a mean weight of 71.5 (12.6) kg (range, 49-103 kg) participated in the study. Levetiracetam did not significantly prolong the QTc(ss). The upper bound of the 1-sided 95% CI for the maximum DeltaDeltaTc(ss) was 8.0 milliseconds for levetiracetam 1000 mg and 8.1 milliseconds for levetiracetam 5000 mg, with mean estimates of 4.0 and 4.1 milliseconds, respectively; similar results were obtained for the maximum DeltaDeltaQTc(F). Moxifloxacin significantly prolonged the QTc(ss), with a lower bound of the 1-sided 95% CI for the maximum DeltaDeltaQTc(ss) of 3.7 milliseconds and a mean estimate of 7.7 milliseconds. There was no statistically significant relationship between measured DeltaQTc(ss) and the levetiracetam plasma concentration, whereas a significant linear relationship was observed between measured DeltaQTc(ss) and the moxifloxacin plasma concentration (slope estimate: 4.4 milliseconds/[microg/mL]); 95% CI, 3.2-5.7; P < 0.001). No unexpected safety concerns arose based on reported adverse events, clinical laboratory evaluations, physical examinations, vital signs, or ECG monitoring during the course of the study. CONCLUSION This randomized, placebo- and active-controlled study in healthy adult subjects found no clinically relevant changes in the QTc interval after a single levetiracetam dose of 1000 or 5000 mg.
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Solomkin J, Zhao YP, Ma EL, Chen MJ, Hampel B. Moxifloxacin is non-inferior to combination therapy with ceftriaxone plus metronidazole in patients with community-origin complicated intra-abdominal infections. Int J Antimicrob Agents 2009; 34:439-45. [PMID: 19692210 DOI: 10.1016/j.ijantimicag.2009.06.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 06/23/2009] [Accepted: 06/26/2009] [Indexed: 11/18/2022]
Abstract
Management of community-origin complicated intra-abdominal infections (cIAIs) requires surgical intervention and antimicrobial therapy. This multinational, randomised, double-blind clinical trial carried out in Asia compared the efficacy and safety of moxifloxacin monotherapy and ceftriaxone/metronidazole combination therapy in adults with confirmed or suspected cIAI. Patients received surgical intervention and either intravenous (i.v.) moxifloxacin 400 mg once daily or i.v. ceftriaxone 2 g once daily plus i.v. metronidazole 500 mg twice daily. A total of 364 patients were randomised [intent-to-treat (ITT), moxifloxacin N=180, comparator N=181; per-protocol (PP), moxifloxacin N=174, comparator N=171]. The most common cIAI diagnosis was complicated appendicitis. Moxifloxacin was non-inferior to ceftriaxone/metronidazole in terms of clinical response at test-of-cure in the PP population [clinical cure, 90.2% for moxifloxacin vs. 96.5% for ceftriaxone/metronidazole; 95% confidence interval (CI) of the difference -11.7 to -1.7] and in the ITT population (87.2% for moxifloxacin vs. 91.2% for ceftriaxone/metronidazole; 95% CI -10.7 to 1.9). Bacteriological cure rates in the microbiologically evaluable population support the clinical results (89.4% for moxifloxacin vs. 95.9% for ceftriaxone/metronidazole; 95% CI -13.3 to -0.6). The incidence of treatment-emergent adverse events was similar for both treatment groups (moxifloxacin 31.7% vs. comparator 24.3%). These results confirm previous findings that moxifloxacin plus adequate source control is an appropriate treatment of cIAI.
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Affiliation(s)
- Joseph Solomkin
- Division of Trauma/Critical Care, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0558, USA.
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Müssig K, Schnauder G, Mörike K. Severe and symptomatic hyponatraemia after moxifloxacin intake. Neth J Med 2009; 67:197. [PMID: 19581673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Conde MB, Efron A, Loredo C, De Souza GRM, Graça NP, Cezar MC, Ram M, Chaudhary MA, Bishai WR, Kritski AL, Chaisson RE. Moxifloxacin versus ethambutol in the initial treatment of tuberculosis: a double-blind, randomised, controlled phase II trial. Lancet 2009; 373:1183-9. [PMID: 19345831 PMCID: PMC2866651 DOI: 10.1016/s0140-6736(09)60333-0] [Citation(s) in RCA: 228] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND New treatments are needed to shorten the time required to cure tuberculosis and to treat drug-resistant strains. The fluoroquinolone moxifloxacin is a promising new agent that might have additive activity to existing antituberculosis agents. We assessed the activity and safety of moxifloxacin in the initial stage of tuberculosis treatment. METHODS We undertook a phase II, double-blind, randomised controlled trial of a regimen that included moxifloxacin in adults with sputum smear-positive tuberculosis at one hospital in Rio de Janeiro, Brazil. 170 participants received isoniazid, rifampicin, and pyrazinamide at standard doses and were assigned by permuted block randomisation to receive either moxifloxacin (400 mg) with an ethambutol placebo (n=85) or ethambutol (15-20 mg/kg) plus moxifloxacin placebo (n=85) 5 days per week for 8 weeks. The primary endpoint was the proportion of patients whose sputum culture had converted to negative by week 8. Analysis was by modified intention to treat (ITT); patients whose baseline cultures were negative, contaminated, or contained drug-resistant Mycobacterium tuberculosis were excluded from the analysis. Additionally, all missing 8-week results were deemed treatment failures. This study is registered with ClinicalTrials.gov, number NCT00082173. FINDINGS 74 patients assigned to the moxifloxacin group and 72 in the ethambutol group were included in the modified ITT population. 125 patients had 8-week data (moxifloxacin n=64, ethambutol n=61); the main reason for absence of data was culture contamination. At 8 weeks, culture conversion to negative had occurred in 59 (80%) of 74 patients in the moxifloxacin group compared with 45 (63%) of 72 in the ethambutol group (difference 17.2%, 95% CI 2.8-31.7; p=0.03). There were 16 adverse events (eight in each group) in 12 patients. Only one event was judged related to study drug (grade 3 cutaneous reaction in the ethambutol group). INTERPRETATION Moxifloxacin improved culture conversion in the initial phase of tuberculosis treatment. Trials to assess whether moxifloxacin can be used to shorten the duration of tuberculosis treatment are justified.
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Affiliation(s)
- Marcus B Conde
- Instituto de Doencas do Torax/Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Torkildsen G, O'Brien TP. Conjunctival tissue pharmacokinetic properties of topical azithromycin 1% and moxifloxacin 0.5% ophthalmic solutions: a single-dose, randomized, open-label, active-controlled trial in healthy adult volunteers. Clin Ther 2009; 30:2005-14. [PMID: 19108788 DOI: 10.1016/j.clinthera.2008.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Effective ocular tissue concentrations and prolonged residence times of antibacterial agents are important in treating both acute and chronic diseases. Conjunctival biopsy allows the determination of specific tissue concentration data for topical ophthalmic agents. Drug concentration analysis at various time points following instillation allows interpretation of the residence time and a rationale for dosing frequency. OBJECTIVE This study compared the pharmacokinetic parameters of 2 currently available topical ocular antibiotics-azithromycin ophthalmic solution 1% and moxifloxacin ophthalmic solution 0.5%-in the conjunctiva of healthy volunteers after a single topical administration. METHODS This single-dose, randomized, open-label, active-controlled clinical trial was conducted at ORA Clinical Research and Development, North Andover, Massachusetts. Subjects were randomly assigned to receive a single dose of azithromycin or moxifloxacin and to undergo biopsy sampling at 30 minutes or 2, 12, or 24 hours after administration. Concentrations of azithromycin and moxifloxacin were determined using liquid chromatography tandem mass spectrometry. Adverse events (AEs) were assessed at all visits using visual acuity measurements, slit-lamp biomicroscopy, and direct questioning. RESULTS Forty-eight subjects (mean age, 40.0 years; 48% female; 96% white, 2% black, and 2% Asian) underwent conjunctival biopsy. Mean (SD) concentrations of azithromycin in conjunctival tissue (lower limit of quantitation [LLOQ], 1 microg/g for 1-mg biopsy specimen) were 131 (89), 59 (19), 48 (24), and 32 (20) microg/g at 30 minutes and 2, 12, and 24 hours, respectively (median values, 117, 69, 46, and 30 microg/g). Mean concentrations concentrations of moxifloxacin in conjunctival tissue (LLOQ, 0.05 microg/g for 1-mg biopsy sample) were 1.92 (2.03), 3.77 (8.98), 0.02 (0.04), and 0.01 (0.02) microg/g at 30 minutes and 2, 12, and 24 hours, respectively (median values, 1.12, 0.12, <0.05, and <0.05 microg/g). Thirteen subjects (6 in the azithromycin group and 7 in the moxifloxacin group) experienced 20 AEs, 11 of which were considered possibly related to study treatment, and 15 of which were ocular (most commonly conjunctival hemorrhage). CONCLUSIONS In this single-dose study of 2 currently available topical ocular antibiotics in healthy volunteers, therapeutic concentrations were achieved with both agents. Both treatments were well tolerated in the population studied. Clinical Trials Identification Number: NCT00564447.
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Prins JM, Koopmans RP. [Novel side effects of moxifloxacin: making a balanced decision again]. Ned Tijdschr Geneeskd 2008; 152:1862-1864. [PMID: 18788675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Earlier this year, a 'Dear Doctor' letter was sent to Dutch health care professionals, describing the rare occurrence of fulminant hepatitis and the Stevens-Johnson syndrome or toxic epidermal necrolysis in patients using moxifloxacin. This resulted in media attention, questions in parliament and moxifloxacin being banned from the formulary in several hospitals. Was this reaction justified? In the Netherlands, moxifloxacin is only mentioned in the practice guideline on the treatment of severe community-acquired pneumonia. Alternatives for moxifloxacin for this indication are penicillin combined with ciprofloxacin, or cephalosporins in combination with erythromycin. The associated risks, in particular fatal anaphylaxis and sudden cardiac death, of these combinations are substantially higher compared to the reported incidence of severe moxifloxacin-associated liver and skin toxicity. 'Dear Doctor' letters are important when new side effects become apparent, but these side effects must be placed in the overall balance of pros and cons of a drug as compared to the alternatives.
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Affiliation(s)
- J M Prins
- Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Inwendige Geneeskunde, onderafd. Infectieziekten, Tropische Geneeskunde en AIDS, Amsterdam.
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Vos MA. Literature-based evaluation of four 'hard endpoint' models for assessing drug-induced torsades de pointes liability. Br J Pharmacol 2008; 154:1523-7. [PMID: 18604235 PMCID: PMC2492098 DOI: 10.1038/bjp.2008.277] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 06/12/2008] [Indexed: 01/28/2023] Open
Abstract
In safety pharmacology, a number of preclinical models for detecting drug-induced proarrhythmia liability have been recently introduced that utilize hard endpoints: early after depolarziations (EADs), torsades de pointes (TdP) or both as the principal biomarker. To explore the validity of four of the most common of these models, (the isolated canine/rabbit left ventricular wedge preparation, the isolated rabbit heart, the methoxamine-pretreated anaesthetized rabbit and the complete, chronic AV-blocked (CAVB) dog (conscious and anaesthetized), the present article reviews published data sets for three drugs with recognized and different human TdP liabilities (cisparide, terfenadine and moxifloxacinin). Finally, this review considers the value of inclusion of analysis of beat-to-beat variability of repolarization (BVR) in TdP liability testing to improve sensitivity and specificity.
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Affiliation(s)
- M A Vos
- Division Heart and Lungs, University Medical Center Utrecht, Alexander Numangebouw, Utrecht, The Netherlands.
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Kovacic D, Fox M, Reichenberg J. Moxifloxacin as the likely cause of drug-induced linear immunoglobulin A bullous dermatosis. J Drugs Dermatol 2008; 7:794-795. [PMID: 18720700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Linear immunoglobulin A bullous dermatosis (LABD) is an immune-mediated subepidermal blistering disease that can be triggered by drug exposures, most notably, vancomycin. The authors report of a case of a 72-year-old man who developed LABD after a course of moxifloxacin. To the authors' knowledge, there is no other case of LABD caused by moxifloxacin in the medical literature.
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Affiliation(s)
- Dianne Kovacic
- Department of Dermatology, University of Texas Medical Branch, Austin, TX 78701, USA
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Harms H, Prass K, Meisel C, Klehmet J, Rogge W, Drenckhahn C, Göhler J, Bereswill S, Göbel U, Wernecke KD, Wolf T, Arnold G, Halle E, Volk HD, Dirnagl U, Meisel A. Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial. PLoS One 2008; 3:e2158. [PMID: 18478129 PMCID: PMC2373885 DOI: 10.1371/journal.pone.0002158] [Citation(s) in RCA: 191] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 03/28/2008] [Indexed: 01/08/2023] Open
Abstract
Background Pneumonia is a major risk factor of death after acute stroke. In a mouse model, preventive antibacterial therapy with moxifloxacin not only prevents the development of post-stroke infections, it also reduces mortality, and improves neurological outcome significantly. In this study we investigate whether this approach is effective in stroke patients. Methods Preventive ANtibacterial THERapy in acute Ischemic Stroke (PANTHERIS) is a randomized, double-blind, placebo-controlled trial in 80 patients with severe, non-lacunar, ischemic stroke (NIHSS>11) in the middle cerebral artery (MCA) territory. Patients received either intravenous moxifloxacin (400 mg daily) or placebo for 5 days starting within 36 hours after stroke onset. Primary endpoint was infection within 11 days. Secondary endpoints included neurological outcome, survival, development of stroke-induced immunodepression, and induction of bacterial resistance. Findings On intention-to treat analysis (79 patients), the infection rate at day 11 in the moxifloxacin treated group was 15.4% compared to 32.5% in the placebo treated group (p = 0.114). On per protocol analysis (n = 66), moxifloxacin significantly reduced infection rate from 41.9% to 17.1% (p = 0.032). Stroke associated infections were associated with a lower survival rate. In this study, neurological outcome and survival were not significantly influenced by treatment with moxifloxacin. Frequency of fluoroquinolone resistance in both treatment groups did not differ. On logistic regression analysis, treatment arm as well as the interaction between treatment arm and monocytic HLA-DR expression (a marker for immunodepression) at day 1 after stroke onset was independently and highly predictive for post-stroke infections. Interpretation PANTHERIS suggests that preventive administration of moxifloxacin is superior in reducing infections after severe non-lacunar ischemic stroke compared to placebo. In addition, the results emphasize the pivotal role of immunodepression in developing post-stroke infections. Trial Registration Controlled-Trials.com ISRCTN74386719
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Affiliation(s)
- Hendrik Harms
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Konstantin Prass
- Department of Neurology, Landesklinikum Waldviertel Horn, Horn, Austria
| | - Christian Meisel
- Institute of Medical Immunology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Juliane Klehmet
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Witold Rogge
- Department of Neurology, Unfallkrankenhaus Berlin, Berlin, Germany
| | | | - Jos Göhler
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan Bereswill
- Department of Microbiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Ulf Göbel
- Department of Microbiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Klaus Dieter Wernecke
- Department of Biometrics and Clinical Epidemiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Tilo Wolf
- Department of Neurology, James Cook University Hospital, Middlesbrough, United Kingdom
| | - Guy Arnold
- Department of Neurology, Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
| | - Elke Halle
- Department of Microbiology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Hans-Dieter Volk
- Institute of Medical Immunology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Ulrich Dirnagl
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - Andreas Meisel
- Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany
- * E-mail:
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Schein J, Janagap-Benson C, Grant R, Sikirica V, Doshi D, Olson W. A comparison of levofloxacin and moxifloxacin use in hospitalized community-acquired pneumonia (CAP) patients in the US: focus on length of stay. Curr Med Res Opin 2008; 24:895-906. [PMID: 18419876 DOI: 10.1185/030079908x273408] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Length of stay (LOS) and hospitalization costs were compared among patients admitted for community-acquired pneumonia (CAP) and initially treated with either levofloxacin 750 mg intravenous (IV) or with moxifloxacin 400 mg IV. Hospital-related complications and relationship of LOS and comorbidities were descriptively examined. METHODS A retrospective database study was conducted of adult patients admitted for CAP and given levofloxacin 750 mg IV or moxifloxacin 400 mg IV through the first 3 days of hospitalization, using the Premier Perspective comparative database. Cohorts were matched 1:1 by hospital geographic location, by coarse caliper propensity scores using all baseline covariates, and by Mahalanobis metric matching based on age and severity (All Patient Refined-Diagnosis-related Groups Severity of Illness (APR-DRG SOI) index). Comparisons between groups were further adjusted for characteristics that remained imbalanced after matching using generalized estimating equation methodology. RESULTS The initial sample of 3868 patients (levofloxacin = 827; moxifloxacin = 3041) was reduced to 1594 (797 patients per treatment group) after matching. Analyses of matched cohorts showed that the mean hospital LOS was significantly shorter for patients treated with levofloxacin 750 mg IV than for those patients treated with moxifloxacin 400 mg IV (5.8 vs. 6.4 days, respectively; least squares mean difference = 0.54 days; p = 0.020). Hospitalization costs were also lower for the levofloxacin 750 mg IV-treated patients (least squares mean difference = US$129; p = 0.753). There were no significant differences in the percentage of patients experiencing complications. LIMITATIONS Although claims databases provide large sample sizes and reflect routine care, they do have several inherent limitations. Since randomization of subjects is not possible, adequate statistical techniques must be used to ensure treatment groups are balanced with respect to patient and clinical characteristics. In addition, data may be missing or miscoded. CONCLUSIONS This retrospective study suggests that among patients hospitalized with CAP, initial treatment with levofloxacin 750 mg IV is associated with a significantly shorter mean hospital LOS compared with treatment with moxifloxacin 400 mg IV. The clinical implications of a shorter hospital LOS include improved patient and economic outcomes.
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Affiliation(s)
- Jeff Schein
- Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, NJ, USA
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Sherazi S, DiSalle M, Daubert JP, Shah AH. Moxifloxacin-induced torsades de pointes. Cardiol J 2008; 15:71-73. [PMID: 18651388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Torsade de pointes (TdP) is increasingly recognized as a complication of drug therapy. The most common cause of drug-induced QT prolongation is inhibition of the rapidly activating component of the delayed potassium current (I(Kr)). Moxifloxacin, a widely used fluoroquinolone, is a weak I(Kr) inhibitor and has been associated with QT prolongation. We report a case of marked QT prolongation (618 ms) and TdP associated with moxifloxacin use. Although it is difficult to predict which patients are at risk from TdP, careful assessment of the risk/benefit ratio is important before prescribing drugs known to cause QT prolongation.
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Affiliation(s)
- Saadia Sherazi
- Unity Health System, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14626, USA
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Son CH, Kim HI, Kim KN, Lee KN, Lee CU, Roh MS, Kim KH, Yang DK, Lee SK. Moxifloxacin-associated drug hypersensitivity syndrome with drug-induced hypersensitivity pneumonitis. J Investig Allergol Clin Immunol 2008; 18:72-73. [PMID: 18361108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Affiliation(s)
- C H Son
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
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Freitas LL, Soriano E, Muccioli C, Höfling-Lima AL, Belfort R. Efficacy and tolerability of a combined moxifloxacin/dexamethasone formulation for topical prophylaxis and reduction of inflammation in phacoemulsification: a comparative, double masked clinical trial. Curr Med Res Opin 2007; 23:3123-30. [PMID: 17980093 DOI: 10.1185/030079907x242629] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the efficacy and safety of a combined 0.5% moxifloxacin and 0.1% dexamethasone formulation (Vigadexa) versus conventional dosing with 0.5% concomitant moxifloxacin (Vigamox) and 0.1% dexamethasone (Maxidex) for the prevention of infection and control of inflammation after cataract surgery. SETTING The ophthalmology clinic and outpatient surgery suite of a public hospital in Brazil. METHODS A prospective, randomized, double-masked, parallel-group study of 139 patients, all of which underwent phacoemulsification and intraocular lens (IOL) implantation. After random assignment, 64 eyes received the combination of topical 0.5% moxifloxacin/0.1% dexamethasone drop and 62 eyes received 0.5% moxifloxacin and 0.1% dexamethasone as separate solutions four times a day for 15 days. Baseline and postoperative assessments were made on surgery days -2, 1, 3, 8, and 15. Limitations of this study included its small size and relatively short duration of follow-up. RESULTS There was no sign of intraocular infection at any time and only minimal inflammation beyond day 3. Physicians rated bacterial infection to be absent in both groups on days 1, 3, 8 and 15. Ninety-seven percent of patients in each group had < or = 5 cells by day 15. Objective and subjective parameters were essentially the same in both treatment groups (p > 0.05). One patient in the conventional therapy group developed viral conjunctivitis unrelated to the surgery. CONCLUSION Treatment with the combined moxiflox acin/dexamethasone eye drops was as effective as conventional treatment in preventing infection and controlling inflammation after phacoemulsification and IOL implantation.
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Affiliation(s)
- Lincoln Lemes Freitas
- Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Altin T, Ozcan O, Turhan S, Ongun Ozdemir A, Akyurek O, Karaoguz R, Guldal M. Torsade de pointes associated with moxifloxacin: a rare but potentially fatal adverse event. Can J Cardiol 2007; 23:907-8. [PMID: 17876386 PMCID: PMC2651372 DOI: 10.1016/s0828-282x(07)70850-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Torsade de pointes occuring due to a long QT interval is a rare but potentially fatal arrhythmia. Acquired long QT develops most commonly because of drugs that prolong ventricular repolarization. It has been reported that fluoroquinolone antimicrobials prolong the corrected QT interval but rarely cause torsade de pointes. A patient with torsade de pointes risk factors (female sex, advanced age, extreme bradycardia and renal failure) who developed the condition on the fourth day of 400 mg/day of oral moxifloxacin treatment is presented. After the moxifloxacin was stopped, the corrected QT interval normalized and a permanent cardiac pacemaker was implanted. During 11 months of follow-up, arrhythmia did not recur.
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Affiliation(s)
- T Altin
- Ankara University School of Medicine, Ankara, Turkey.
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