Tuberculosis moxifloxacin

Ciprofloxacin and levofloxacin are no longer recommended for the treatment of gonococcal infection in the USA as resistance is now common. However, both drugs are effective in treating chlamydial urethritis or cervicitis. Ciprofloxacin, levofloxacin, or moxifloxacin is occasionally used for treatment of tuberculosis and atypical mycobacterial infections. These agents may be suitable for eradication of meningococci from carriers or for prophylaxis of infection in neutropenic patients. 

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... 

Gillespie SH et al Early bactericidal activity of a moxifloxacin and isoniazid combination in smear-positive pulmonary tuberculosis. J Antimicrob Chemother 2005 56 1169. [PMID 16223939]... 

Mycobacterium tuberculosis Isoniazid + rifampin + ethambutol + pyrazinamide Streptomycin, moxifloxacin, amikacin, ethionamide, cycloserine, PAS, linezolid... 

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]. 

Ji B, et al. In vitro and in vivo activities of moxifloxacin and clinafloxacin against Mycobacterium tuberculosis. Antimicrob. Agents Chemother., 1998, 42, 2066-2069. 

Rodriguez JC, et al. In vitro activity of moxifloxacin, levofloxacin, gatifloxacin and linezolid against Mycobacterium tuberculosis. Int. J. Antimicrob. Agents, 2002, 20, 464-467. 

Tortoli E, Dionisio D, Fabbri C. Evaluation of moxifloxacin activity in vitro against Mycobacterium tuberculosis, including resistant and multidrug-resistant strains./. Chemother., 2004, 14, 334-336. 

M. tuberculosis Isoniazid -1- rifampin - -pyrazinamide -1- ethambutol or streptomycin Moxifloxacin or gatifloxacin cycloserine capreomycin kanamycin amikacin ethionamide clofazimine aminosalicylic acid... 

Mycobacterium tuberculosis (extensively drug-resistant) Lung Drug combinations (strepto-mycin/isonicotinyl/ hydrazine/rifampin/ ethambutol/pyrazinamide/ moxifloxacine/cycloser-ine/imipenem/co-amoxi-clav/clofazimine/ prochlorperazine/ metronidazole), PA-824 and R207910... 

The bone marrow aspirate showed normal haematopoiesis with absent iron storage and negative cultures for M. tuberculosis. She was started on INH, RMP, PYZ and Emb. However, INH had to be changed to moxifloxacin early in the course of therapy due to hepatotoxicity. Haemoglobin dropped progressively to 53g/l over... 

---