Fluoroquinolones moxifloxacin

The powerful activity of the more recent fluoroquinolones moxifloxacin, gati-floxacin and levofloxacin against clinical isolates of S. pneumoniae, H. influenzae and M. catarrhalis isolated in various European countries in 2000-2001 and the low rates of resistance to these compounds have been demonstrated in a clinical study [190]. 

After anterior stromal puncture, PTK, or superficial keratectomy, broad-spectrum topical prophylactic ophthalmic antibiotic drops such as 0.3% tobramycin, 0.3% ciprofloxacin, or one of the newer generation fluoroquinolones, moxifloxacin or gatifloxacin, should be instilled three to four times daily, along with a broad-spectrum antibiotic ointment such as 0.3% tobramycin or 0.3% ciprofloxacin instilled into the conjunctival sac at bedtime. NSAIDs such as diclofenac sodium 0.1% solution... 

The fluoroquinolones include ciprofloxacin (Cipro), enoxacin (Penetrex), gatifloxacin (Tequin), lome-floxacin (Maxaquin), moxifloxacin (Avelox), ofloxacin (Floxin), and sparfloxacin (Zagain). 

Concurrent use of the fluoroquinolones with theophylline causes an increase in serum theophylline levels. When used concurrently with cimetidine, the cimetidine may interfere with the elimination of the fluoroquinolones. Use of the fluoroquinolones with an oral anticoagulant may cause an increase in the effects of the oral coagulant. Administration of the fluoroquinolones with antacids, iron salts, or zinc will decrease absorption of the fluoroquinolones. There is a risk of seizures if fluoroquinolones are given with the NSAIDs. There is a risk of severe cardiac arrhythmias when the fluoroquinolones gatifloxacin and moxifloxacin are administered with drains that increase the QT interval (eg, quini-dine, procainamide, amiodarone, and sotalol). 

Complicated exacerbation FEV, less than 50% predicted Comorbid cardiac disease Greater than or equal to 3 exacerbations per year Antibiotic therapy in the previous 3 months Above organisms plus drug-resistant pneumococci, P-lactamase-producing H. influenzae and M. catarrhalis, Escherichia coli, Proteus spp., Enterobacter spp., Klebsiella pneumoniae Oral P-Lactam/P-Iactamase inhibitor (amoxicil 1 i n-clavulanate) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin) Intravenous P-Iactam/P-Iactamase inhibitor (ampicillin-sulbactam) Second- or third-generation cephalosporin (cefuroxime, ceftriaxone) Fluoroquinolone with enhanced pneumococcal activity (levofloxacin, moxifloxacin)... 

Because an infection slows the healing of a corneal abrasion, prophylactic antibiotics are often used. Studies on the efficacy of this are mixed. Discontinue the use of contact lenses until the abrasion is healed and the antibiotic course complete. In contact lens wearers, choose an antibiotic that covers Pseudomonas aeruginosa, like gentamicin ointment or solution or a fluoroquinolone.3 Antibiotic resistance is an increasing problem. Resistance occurs primarily with older antibiotics, but has been reported for fluoroquinolones as well. Two newer fluoroquinolones, gatifloxacin and moxifloxacin, do not yet have reports of resistance. These agents are more expensive.6... 

Fluoroquinolone (levofloxacin 750 mg eveiy 24 or moxifloxacin 400 mg eveiy 24 hours) + metronidazole 250-500 mg every 8 hours or clindamycin 300-600 mg every 6-8 hours0... 

For penicillin-allergic adults, use a fluoroquinolone (ciprofloxacin 0.5-0.75 g orally every 12 hours or 0.4 g IV every 12 hours levofloxacin 0.5-0.75 g orally or IV every 24 hours or moxifloxacin 0.4 g orally or IV every 24 hours). eGentamicin or tobramycin, 2 mg/kg loading dose, then maintenance dose as determined by serum concentrations, fluoroquinolone or aztreonam 1 g IV every 6 hours may be used in place of the aminoglycoside in patients with severe renal dysfunction or other relative contraindications to aminoglycoside use. 

In complicated exacerbations where drug-resistant pneumococci, /J-lacta-mase-producing H. influenzae and M. catarrhalis, and some enteric gramnegative organisms maybe present, recommended therapy includes amox-icillin/clavulanate or a fluoroquinolone with enhanced pneumococcal activity (levofloxacin, gemifloxacin, moxifloxacin). 

Levofloxacin, gatifloxacin, gemifloxacin, and moxifloxacin, so-called respiratory fluoroquinolones, with their enhanced gram-positive activity and activity against atypical pneumonia agents (eg, chlamydia, mycoplasma, and legionella), are effective and used increasingly for treatment of upper and lower respiratory tract infections. 

Fluoroquinolones are extremely well tolerated. The most common effects are nausea, vomiting, and diarrhea. Occasionally, headache, dizziness, insomnia, skin rash, or abnormal liver function tests develop. Photosensitivity has been reported with lomefloxacin and pefloxacin. QTC prolongation may occur with gatifloxacin, levofloxacin, gemifloxacin, and moxifloxacin, which should be avoided or used with caution in patients with known QTC interval prolongation or uncorrected... 

Moxifloxacin Oral, TV "respiratory" fluoroquinolone once-daily dosing improved activity versus anaerobes and Mycobacterium tuberculosis hepatic clearance results in lower urinary levels so use in urinary tract infections is not recommended... 

In the treatment of tuberculosis, resistant strains of M. tuberculosis (multidrug-resistant tuberculosis, MDRTB) present a growing problem, so that new antituber-culotic agents are required which act according to a different mechanism to that of standard agents such as isoniazid, rifampicin, pyrazinamide, and ethambutol. The more modern fluoroquinolones are of particular interest, and in particular moxifloxacin, which has powerful in vitro and in vivo activity and, in contrast to sparfloxacin and clinafloxacin, is not photo toxic [191]. 

Moxifloxacin s MIC90 value of 1 mg L"1 means that it has the same in vitro activity against M. tuberculosis as levofloxacin, and is more effective than ofloxacin (MIC90 = 2 mg L"1) and ciprofloxacin (MIC90 = 4 mg IT1) [192-194]. A combination of moxifloxacin and isoniazid proved to be more effective in vivo than the individual compounds [195,196], whereas a combination with ethambutol was less effective [196]. Based on the mutant prevention concentration (MPC), which is a parameter for the selection of resistant pathogens during antibiotic treatment, moxifloxacin was found to be the most effective fluoroquinolone against M. tuberculosis [197]. 

A comparative study of the pharmacokinetic and pharmacodynamic properties of the more modern fluoroquinolones [218,219], as well as overviews on the pharmacokinetics [163,220] and pharmacodynamics [221] of moxifloxacin, can be found in the literature. 

Moxifloxacin s pharmacokinetics are neither age- nor sex-dependent [228], although special measures may be required when treating older patients with restricted organ function with fluoroquinolones [229]. 

An increased expression of efflux pumps, which prevents accumulation of the quinolone in the bacterial cell. Thus, the efflux pump NorA is responsible for the reduced sensitivity of S. aureus to hydrophilic fluoroquinolones such as norfloxacin, ciprofloxacin and ofloxacin, whereas quinolones such as sparfloxacin, trovafloxacin and moxifloxacin are not as greatly affected thereby. 

The evolution of the quinolones, which began with nalidixic acid and has produced the modem fluoroquinones moxifloxacin, gatifloxacin and gemifloxacin, was based not only on modifications of the basic quinolone structure but also on the development of new cyclic amines for the 7-position. The cyclopropyl radical, which was introduced for the first time in ciprofloxacin, remains the most effective substituent for the 1-position. Moxifloxacin is an 8-methoxy fluoroquinolone with a novel enantiomerically pure S,S-2,8-diazabicyclo[4.3.0]non-8-yl radical in the 7-position. 

Moxifloxacin has a broad spectrum of activity which includes Gram-positive cocci, atypical pathogens and anaerobic bacteria responsible, inter alia, for infections of the respiratory tract. Moreover, moxifloxacin is one of the most effective fluoroquinolones against pneumococci, including the penicillin- and macrolide-resistant strains. The development of resistance to moxifloxacin is slower than that of the other fluoroquinolones. 

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