Moxifloxacin Population Pharmacokinetics and Model-Based Comparison of Efficacy between Moxifloxacin and Ofloxacin in African Patients
In: Antimicrobial agents and chemotherapy, Jg. 58 (2014), Heft 1, S. 503-510
Online
academicJournal
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Zugriff:
Pharmacokinetic exposure and the MIC of fluoroquinolones are important determinants of their efficacy against Mycobacterium tuberculosis. Population modeling was used to describe the steady-state plasma pharmacokinetics of moxifloxacin in 241 tuberculosis (TB) patients in southern Africa. Monte Carlo simulations were applied to obtain the area under the unbound concentration-time curve from 0 to 24 h (fAUC0-24) after daily doses of 400 mg or 800 mg moxifloxacin and 800 mg ofloxacin. The MIC distributions of ofloxacin and moxifloxacin were determined for 197 drug-resistant clinical isolates of Mycobacterium tuberculosis. For a specific MIC, the probability of target attainment (PTA) was determined for target fAUC0-24/MIC ratios of ≥53 and ≥100. The PTAs were combined with the MIC distributions to calculate the cumulative fraction of response (CFR) for multidrug-resistant (MDR) Mycobacterium tuberculosis strains. Even with the less stringent target ratio of ≥53, moxifloxacin at 400 mg and ofloxacin at 800 mg achieved CFRs of only 84% and 58% for multidrug-resistant isolates with resistance to an injectable drug, while the 800-mg moxifloxacin dose achieved a CFR of 98%. Using a target ratio of ≥ 100 for multidrug-resistant strains (without resistance to injectable agents or fluoroquinolones), the CFR was 88% for moxifloxacin and only 43% for ofloxacin, and the higher dose of 800 mg moxifloxacin was needed to achieve a CFR target of > 90%. Our results indicate that moxifloxacin is more efficacious than ofloxacin in the treatment of MDR-TB. Further studies should determine the optimal pharmacodynamic target for moxifloxacin in a multidrug regimen and clarify safety issues when it is administered at higher doses.
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Moxifloxacin Population Pharmacokinetics and Model-Based Comparison of Efficacy between Moxifloxacin and Ofloxacin in African Patients
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Autor/in / Beteiligte Person: | ZVADA, Simbarashe P ; DENTI, Paolo ; HARRISON, Thomas ; MCILLERON, Helen M ; SIRGEL, Frederick A ; CHIGUTSA, Emmanuel ; HATHERILL, Mark ; CHARALAMBOUS, Salome ; MUNGOFA, Stanley ; WIESNER, Lubbe ; SIMONSSON, Ulrika S. H ; JINDANI, Amina |
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Zeitschrift: | Antimicrobial agents and chemotherapy, Jg. 58 (2014), Heft 1, S. 503-510 |
Veröffentlichung: | Washington, DC: American Society for Microbiology, 2014 |
Medientyp: | academicJournal |
Umfang: | print, 50 ref |
ISSN: | 0066-4804 (print) |
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