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Kiymaci ME, Topal GR, Esim O, Bacanli M, Ozkan CK, Erdem O, Savaser A, Ozkan Y. Evaluation of bacterial uptake, antibacterial efficacy against Escherichia coli, and cytotoxic effects of moxifloxacin-loaded solid lipid nanoparticles. Arh Hig Rada Toksikol 2022; 73:260-269. [PMID: 36607722 PMCID: PMC9985348 DOI: 10.2478/aiht-2022-73-3667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/01/2022] [Accepted: 11/01/2022] [Indexed: 01/07/2023] Open
Abstract
Moxifloxacin (MOX) is an important antibiotic commonly used in the treatment of recurrent Escherichia coli (E. coli) infections. The aim of this study was to investigate its antibacterial efficiency when used with solid lipid nanoparticles (SNLs) and nanostructured lipid carriers (NLCs) as delivery vehicles. For this purpose we designed two SLNs (SLN1 and SLN2) and two NLCs (NLC1 and NLC2) of different characteristics (particle size, size distribution, zeta potential, and encapsulation efficiency) and loaded them with MOX to determine its release, antibacterial activity against E. coli, and their cytotoxicity to the RAW 264.7 monocyte/macrophage-like cell line in vitro. With bacterial uptake of 57.29 %, SLN1 turned out to be significantly more effective than MOX given as standard solution, whereas SLN2, NLC1, and NLC2 formulations with respective bacterial uptakes of 50.74 %, 39.26 %, and 32.79 %, showed similar activity to standard MOX. Cytotoxicity testing did not reveal significant toxicity of nanoparticles, whether MOX-free or MOX-loaded, against RAW 264.7 cells. Our findings may show the way for a development of effective lipid carriers that reduce side effects and increase antibacterial treatment efficacy in view of the growing antibiotic resistance.
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Affiliation(s)
- Merve Eylul Kiymaci
- University of Health Sciences Turkey, Gülhane Faculty of Pharmacy, Department of Pharmaceutical Microbiology, Ankara, Turkey
| | - Gizem Ruya Topal
- University of Health Sciences Turkey, Gülhane Faculty of Pharmacy, Department of Pharmaceutical Biotechnology, Ankara, Turkey
| | - Ozgur Esim
- University of Health Sciences Turkey, Gülhane Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Merve Bacanli
- University of Health Sciences Turkey, Gülhane Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey
| | - Cansel Kose Ozkan
- University of Health Sciences Turkey, Gülhane Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Onur Erdem
- University of Health Sciences Turkey, Gülhane Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey
| | - Ayhan Savaser
- University of Health Sciences Turkey, Gülhane Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
| | - Yalcin Ozkan
- University of Health Sciences Turkey, Gülhane Faculty of Pharmacy, Department of Pharmaceutical Technology, Ankara, Turkey
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2
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Structural and probing dynamics of Brij-35-based microemulsion for fluoroquinolone antibiotics. Colloid Polym Sci 2021. [DOI: 10.1007/s00396-021-04871-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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3
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Duane TM, Huston JM, Collom M, Beyer A, Parli S, Buckman S, Shapiro M, McDonald A, Diaz J, Tessier JM, Sanders J. Surgical Infection Society 2020 Updated Guidelines on the Management of Complicated Skin and Soft Tissue Infections. Surg Infect (Larchmt) 2021; 22:383-399. [PMID: 33646051 DOI: 10.1089/sur.2020.436] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The Surgical Infection Society (SIS) Guidelines for the treatment of complicated skin and soft tissue infections (SSTIs) were published in October 2009 in Surgical Infections. The purpose of this project was to provide a succinct update on the earlier guidelines based on an additional decade of data. Methods: We reviewed the previous guidelines eliminating bite wounds and diabetic foot infections including their associated references. Relevant articles on the topic of complicated SSTIs from 2008-2020 were reviewed and graded individually. Comparisons were then made between the old and the new graded recommendations with review of the older references by two authors when there was disparity between the grades. Results: The majority of new studies addressed antimicrobial options and duration of therapy particularly in complicated abscesses. There were fewer updated studies on diagnosis and specific operative interventions. Many of the topics addressed in the original guidelines had no new literature to evaluate. Conclusions: Most recommendations remain unchanged from the original guidelines with the exception of increased support for adjuvant antimicrobial therapy after drainage of complex abscess and increased data for the use of alternative antimicrobial agents.
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Affiliation(s)
| | - Jared M Huston
- Departments of Surgery and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Adam Beyer
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sara Parli
- Department of Pharmacy Services, University of Kentucky, Lexington, Kentucky, USA
| | - Sara Buckman
- Department of Surgery, Washington University, St. Louis, Missouri, USA
| | - Mark Shapiro
- Acute Care Surgery, Portsmouth, New Hampshire, USA
| | - Amy McDonald
- Department of Veterans Affairs, Cleveland, Ohio, USA
| | - Jose Diaz
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Jeffrey M Tessier
- Division of Infectious Diseases, University of Texas Southwestern, Dallas Texas, USA
| | - James Sanders
- Department of Pharmacy and Division of Infectious Diseases, University of Texas Southwestern, Dallas, Texas, USA
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4
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Abdelghany S, Parumasivam T, Pang A, Roediger B, Tang P, Jahn K, Britton WJ, Chan HK. Alginate modified-PLGA nanoparticles entrapping amikacin and moxifloxacin as a novel host-directed therapy for multidrug-resistant tuberculosis. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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5
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Marusza W, Olszanski R, Sierdzinski J, Ostrowski T, Szyller K, Mlynarczyk G, Netsvyetayeva I. Treatment of late bacterial infections resulting from soft-tissue filler injections. Infect Drug Resist 2019; 12:469-480. [PMID: 30863129 PMCID: PMC6390860 DOI: 10.2147/idr.s186996] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose Late bacterial infections (LBIs) after esthetic facial augmentation using hyaluronic acid (HA) fillers are relatively rare yet severe complications that are difficult to treat. No adequate treatment standards have hitherto been formulated. We have bridged this gap by formulating a treatment scheme based on the principles of treating foreign-body implantation-related infections and treating bacterial growth in the form of biofilm. The objective of this study was to evaluate the efficacy of a comprehensive scheme for treating LBI complications after facial augmentation using cross-linked HA fillers. Methods A total of 22 patients with LBI symptoms at a site of cross-linked HA injection underwent treatment and observation. The comprehensive treatment scheme formulated by Marusza and Netsvyetayeva (M&N scheme) comprised draining the lesion, dissolution of cross-linked HA with hyaluronidase, broad-spectrum antibiotic combination therapy, and use of probiotics. While 17 patients underwent the M&N scheme, the remaining five were treated with other schemes. Statistical analysis of the data was performed using Mann–Whitney U and χ2 nonparametric tests with SAS 9.4 software. Results All 17 patients who underwent the M&N scheme experienced resolution of symptoms, with no recurrence of infection at the HA-injection sites. Conclusion To treat LBI at a site of cross-linked HA administration, the principles applicable to infections resulting from implantation of a foreign body must be followed. The treatment period should be sufficiently long for complete resolution of symptoms. The efficacy of treatment is considered proven if 2 months have elapsed without recurrence since the symptoms resolved. The M&N scheme is recommended for use as the first therapeutic option for treating LBI related to soft-tissue fillers.
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Affiliation(s)
| | | | - Janusz Sierdzinski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Ostrowski
- Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland
| | | | - Grazyna Mlynarczyk
- Department of Microbiology, Medical University of Warsaw, Warsaw, Poland,
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6
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Singh B, Kumar R. Designing biocompatible sterile organogel–bigel formulations for drug delivery applications using green protocol. NEW J CHEM 2019. [DOI: 10.1039/c8nj05480k] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Present article discusses the formation of a bigel formulation for drug delivery applications via a newly developed green approach using gamma radiation induced crosslinking.
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Affiliation(s)
- Baljit Singh
- Department of Chemistry
- Himachal Pradesh University
- Shimla-171005
- India
| | - Rajender Kumar
- Department of Chemistry
- Himachal Pradesh University
- Shimla-171005
- India
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7
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Takimoto K, Wang Q, Suzuki D, Katayama M, Hayashi Y. Clinical efficacy of piperacillin/tazobactam in the treatment of complicated skin and soft tissue infections. Expert Opin Pharmacother 2017. [PMID: 28627952 DOI: 10.1080/14656566.2017.1341491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Complicated skin and soft tissue infections (cSSTIs) are skin and soft tissue infections (SSTIs) that involve deep soft tissue. cSSTIs often require surgical intervention and/or hospitalization. cSSTIs are associated with significant mortality and morbidity, and carry a significant burden on health care systems. Piperacillin/tazobactam has been regarded as a standard treatment for cSSTIs because of its antibiotic spectrum, safety and clinical efficacy. Several antibiotics, as compared to piperacillin/tazobactam, have been evaluated in the treatment of cSSTIs. Areas covered: This review summarizes randomized controlled trials (RCTs) evaluating the clinical efficacy of piperacillin/tazobactam for the treatment of cSSTIs. Expert opinion: Piperacillin/tazobactam, which covers most causative organisms in cSSTIs, is the drug of choice for the treatment of cSSTIs. Other options such as ertapenem and moxifloxacin may be reasonable where multiple daily dosing or intravenous administration is inappropriate. But in general, they should be avoided as an empirical treatment because of their highly association with resistant bacteria, which are becoming a global threat. Therefore, piperacilin/tazobactam is appropriate as an empirical therapy for the treatment of SSTIs and should be de-escalated as soon as causative organisms are identified, their drug-sensitivity results are available, and clinical condition becomes stable.
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Affiliation(s)
- Kohei Takimoto
- a Department of Intensive Care Medicine , Kameda Medical Center , Kamogawa , Japan
| | - Qianzhi Wang
- b Postgraduate Education Center , Kameda Medical Center , Kamogawa , Japan
| | - Daisuke Suzuki
- c Department of Infectious Diseases , Kameda Medical Center , Kamogawa , Japan
| | - Mitsuya Katayama
- d Department of General Internal Medicine , Kameda Medical Center , Kamogawa , Japan
| | - Yoshiro Hayashi
- a Department of Intensive Care Medicine , Kameda Medical Center , Kamogawa , Japan
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8
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Kalchbrenner K. Managing Common Bite Wounds and Their Complications in the United States. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Singh B, Kumar A. Radiation formation of functionalized polysaccharide-protein based skin mimicking semi- inter penetrating network for biomedical application. Int J Biol Macromol 2016; 92:1136-1150. [DOI: 10.1016/j.ijbiomac.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/03/2016] [Accepted: 08/05/2016] [Indexed: 11/17/2022]
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10
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Wang C, Han C, Geng N, Fan A, Wang Y, Yue Y, Zhang H, Xue F. Efficacy of oral moxifloxacin for aerobic vaginitis. Eur J Clin Microbiol Infect Dis 2015; 35:95-101. [DOI: 10.1007/s10096-015-2513-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/19/2015] [Indexed: 12/01/2022]
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Singh B, Dhiman A. Designing bio-mimetic moxifloxacin loaded hydrogel wound dressing to improve antioxidant and pharmacology properties. RSC Adv 2015. [DOI: 10.1039/c5ra06857f] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recently, it has been found that moxifloxacin, an antibiotic drug, promotes wound healing without induction to bacterial resistance.
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Affiliation(s)
- Baljit Singh
- Department of Chemistry
- Himachal Pradesh University
- Shimla - 171005
- India
| | - Abhishek Dhiman
- Department of Chemistry
- Himachal Pradesh University
- Shimla - 171005
- India
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12
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Empirical treatment of highly suspected nontuberculous mycobacteria infections following aesthetic procedures. Arch Plast Surg 2014; 41:759-67. [PMID: 25396192 PMCID: PMC4228222 DOI: 10.5999/aps.2014.41.6.759] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/10/2014] [Accepted: 07/17/2014] [Indexed: 11/13/2022] Open
Abstract
Background Infection caused by nontuberculous mycobacteria (NTM) has been increasing. Awareness of this infection is crucial yet problematic. Delayed management may lead to destructive results. We empirically treated a series of patients with clinical suspicion of NTM infection prior to the identification of the pathogen. Methods A total of 12 patients who developed surgical site infections between January 2011 and February 2014 were reviewed. Patients with a skin and subcutaneous infection resistant to standard management over two weeks, and previous history of aesthetic procedures within three months were regarded as highly suspected of having an NTM infection. A variety of diagnostic modalities were examined simultaneously, along with starting empirical treatment including a combination of clarithromycin and moxifloxacin, and surgical debridement. Results All wounds healed completely within 4 weeks. The mean follow-up duration was 7.2 months, and none of the patients developed relapse. Specific NTM pathogens were identified in six patients. Eight patients showed caseating granuloma implying an NTM infection. One patient showed an uncommon Stenotrophomonas infection, which was successfully treated. Three patients had no evidence of a pathogen despite repeated microbial tests. Complications such as scarring, pigmentation, and disfigurement were common in all the patients. Conclusions NTM should be considered in the differential diagnosis of an unusual skin and soft-tissue infection. We propose an empirical regimen of clarithromycin and moxifloxacin as an efficient treatment option for an NTM infection.
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Lode HM. Preserving the efficacy of front-line fluoroquinolones through selective use to optimise clinical outcomes. Int J Antimicrob Agents 2014; 43:497-507. [DOI: 10.1016/j.ijantimicag.2014.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 02/18/2014] [Accepted: 02/20/2014] [Indexed: 01/06/2023]
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Burkhardt O, Welte T. 10 years’ experience with the pneumococcal quinolone moxifloxacin. Expert Rev Anti Infect Ther 2014; 7:645-68. [DOI: 10.1586/eri.09.46] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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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] [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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Moxifloxacin in complicated skin and skin structure infections (cSSSIs): A prospective, international, non-interventional, observational study. Adv Ther 2013; 30:630-43. [PMID: 23797470 PMCID: PMC3706718 DOI: 10.1007/s12325-013-0038-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Indexed: 01/22/2023]
Abstract
Introduction ARTOS was an international, prospective, non-interventional, non-controlled observational study designed to determine the effectiveness, safety, and tolerability of moxifloxacin under daily-life conditions in patients with complicated skin and skin structure infections (cSSSIs) treated in Europe, the Middle East, and Asia–Pacific region. Methods Eligible patients included males and females who were hospitalized patients or outpatients requiring antibiotic therapy for cSSSIs and for whom the treating physician had elected to begin moxifloxacin therapy in accordance with its approved indications. Patients were assessed before therapy and then at one or two follow-up visits. Effectiveness was assessed with respect to improvement and resolution of signs and symptoms of cSSSIs and safety with respect to the nature and frequency of adverse events and adverse drug reactions. Results A total of 6,594 patients were enrolled of whom 5,444 had data available for analysis; 4,692 patients received sequential intravenous/oral (IV/PO) moxifloxacin and 752 exclusively IV therapy. A majority of patients were aged between 40 and 79 years and had one or more comorbid conditions. Post-surgical wound infection, skin abscess, and diabetic foot infection were the cSSSIs most frequently diagnosed and treated with moxifloxacin, with almost 90% of infections rated moderate or severe. Treating physicians chose sequential moxifloxacin 400 mg for most patients, switching from IV to PO after 3–4 days. On average, treatment was maintained for 10 days. Treatment with moxifloxacin was associated with rapid relief in symptoms, with 93.2% of patients experiencing either complete resolution of symptoms or improvement at follow-up. Moxifloxacin was well tolerated with adverse drug reactions occurring in only 2% of patients. Conclusions This study, conducted in a ‘real-world’ setting, confirms the effectiveness and safety of moxifloxacin in the treatment of a wide spectrum of cSSSIs seen in routine clinical practice.
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Gyssens IC, Dryden M, Kujath P, Nathwani D, Schaper N, Hampel B, Reimnitz P, Alder J, Arvis P. A randomized trial of the efficacy and safety of sequential intravenous/oral moxifloxacin monotherapy versus intravenous piperacillin/tazobactam followed by oral amoxicillin/clavulanate for complicated skin and skin structure infections. J Antimicrob Chemother 2011; 66:2632-42. [PMID: 21896561 PMCID: PMC3191944 DOI: 10.1093/jac/dkr344] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The primary aim of the RELIEF study was to evaluate the efficacy and safety of two sequential intravenous (iv)/oral regimens: moxifloxacin iv/oral versus piperacillin/tazobactam (TZP) iv followed by oral amoxicillin/clavulanate (AMC). PATIENTS AND METHODS The study had a prospective, randomized, double-dummy, double-blind, multicentre design. Patients ≥18 years were prospectively stratified according to complicated skin and skin structure infection (cSSSI) subtype/diagnosis (major abscess, diabetic foot infection, wound infection or infected ischaemic ulcer), surgical intervention and severity of illness. Diagnoses and disease severity were based on predetermined criteria, documented by repeated photographs, and confirmed by an independent data review committee. Patients were randomized to receive either 400 mg of moxifloxacin iv once daily followed by 400 mg of moxifloxacin orally once daily or 4.0/0.5 g of TZP iv thrice daily followed by 875/125 mg of AMC orally twice daily for 7-21 days. The primary efficacy variable was clinical response at test of cure (TOC) for the per-protocol (PP) population. Clinical efficacy was assessed by the data review committee based on repeated photographs and case descriptions. Clinical trials registry number: NCT 00402727. RESULTS A total of 813 patients were randomized. Clinical success rates at TOC were similar for moxifloxacin and TZP-AMC in the PP [320/361 (88.6%) versus 275/307 (89.6%), respectively; P = 0.758] and intent-to-treat (ITT) [350/426 (82.2%) versus 305/377 (80.9%), respectively; P = 0.632] populations. Thus, moxifloxacin was non-inferior to TZP-AMC. Bacteriological success rates were high in both treatment arms [moxifloxacin: 432/497 (86.9%) versus TZP-AMC: 370/429 (86.2%), microbiologically valid (MBV) population]. Moxifloxacin was non-inferior to TZP-AMC at TOC in both the MBV and the ITT populations. Both treatments were well tolerated. CONCLUSIONS Once-daily iv/oral moxifloxacin monotherapy was clinically and bacteriologically non-inferior to iv TZP thrice daily followed by oral AMC twice daily in patients with cSSSIs.
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Affiliation(s)
- Inge C Gyssens
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Magyar A, Garaczi E, Hajdú E, Kemény L. [Empirical antibiotic therapy of complicated skin and soft tissue infections in dermatological practice]. Orv Hetil 2011; 152:252-8. [PMID: 21296734 DOI: 10.1556/oh.2011.28968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED Erysipelas is an acute bacterial infection of the skin predominantly caused by Streptococcus pyogenes. According to the international classification complicated erysipelas belongs to the complicated skin and soft tissue infections. Complicated infections are defined as severe skin involvement or when the infection occurs in compromised hosts. These infections frequently involve Gram-negative bacilli and anaerobic bacteria. AIMS The aim of this study was to compare the efficacy of the empirical antibiotic therapy for the patients who were admitted to the Department of Dermatology and Allergology, University of Szeged. METHODS The empirical therapy was started according to a previously determined protocol. The data of 158 patients with complicated skin and soft tissue infections were analyzed and the microbiology culture specimens and the isolates were also examined. RESULTS AND CONCLUSIONS The results show that penicillin is the first choice for the treatment of erysipelas. However, the complicated skin and soft tissue infections require broad-spectrum antibiotics.
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Affiliation(s)
- Andrea Magyar
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Bőrgyógyászati és Allergológiai Klinika, Szeged
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Efficacy of topically delivered moxifloxacin against wound infection by Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2011; 55:2325-34. [PMID: 21343458 DOI: 10.1128/aac.01071-10] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Wound infection is a common risk for patients with chronic nonhealing wounds, causing high morbidity and mortality. Currently, systemic antibiotic treatment is the therapy of choice, despite often leading to several side effects and the risk of an insufficient tissue penetration due to impaired blood supply. If systemically delivered, moxifloxacin penetrates well into inflammatory blister fluid, muscle, and subcutaneous adipose tissues and might therefore be a possible option for the topical treatment of skin and infected skin wounds. In this study, topical application of moxifloxacin was investigated in comparison to mupirocin, linezolid, and gentamicin using a porcine wound infection and a rat burn infection model. Both animal models were performed either by an inoculation with methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa. Wound fluid, tissue, and blood samples were taken, and bacterial counts as well as the moxifloxacin concentration were determined for a 14-day follow-up. A histological comparison of the rat burn wound tissues was performed. Both strains were susceptible to moxifloxacin and gentamicin, whereas mupirocin and linezolid were effective only against MRSA. All antibiotics showed efficient reduction of bacterial counts, and except with MRSA, infected burn wounds reached bacterial counts below 10(5) CFU/g tissue. Additionally, moxifloxacin was observed to promote wound healing as determined by histologic analysis, while no induction of bacterial resistance was observed during the treatment period. The use of topical antibiotics for the treatment of infected wounds confers many benefits. Moxifloxacin is therefore an ideal candidate, due to its broad antibacterial spectrum, its high efficiency, and its potential to promote wound healing.
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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] [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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Stass H, Delesen H, Kubitza D, Mai I, Bauer S, Roots I. Moxifloxacin does not Alter Ciclosporin Pharmacokinetics in Transplant Patients. Clin Drug Investig 2010. [DOI: 10.2165/11534310-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Capone D, Tarantino G, Polichetti G, Kadilli I, Sabbatini M, Basile V, Carrano R, Nappi R, Federico S. Absence of pharmacokinetic interference of moxifloxacin on cyclosporine and tacrolimus in kidney transplant recipients. J Clin Pharmacol 2010; 50:576-80. [PMID: 20089827 DOI: 10.1177/0091270009347869] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study investigates the potential pharmacokinetic interactions between an antimicrobial agent, moxifloxacin, and 2 immunosuppressant drugs, cyclosporine and tacrolimus, in kidney transplant recipients. Twenty-two kidney transplant patients needing antibiotic therapy for urinary tract infections are enrolled. Eleven patients are under cyclosporine treatment and the other 11 patients are under tacrolimus treatment. Because the urinary tract infections are caused by gram-negative aerobes sensitive to moxifloxacin, this antibiotic is administered by oral route at a dose of 400 mg/d for 1 week; in each patient pharmacokinetic studies are carried out before and at the seventh day of therapy. For both immunosuppressors, none of the pharmacokinetic parameters investigated show statistically significant differences between values obtained before and during treatment with moxifloxacin. In fact, the concentration-time profiles of monoclonal cyclosporine, polyclonal cyclosporine, and tacrolimus are not significantly different before and during the antimicrobial therapy. The results of the present study rule out interference of moxifloxacin with both cyclosporine and tacrolimus kinetics and indicate that the concomitant administration of the fluoroquinolone and cyclosporine or tacrolimus does not require modifications of the dosages of 2 immunosuppressant drugs.
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Affiliation(s)
- Domenico Capone
- Department of Neurosciences, Unit of Clinical Pharmacology. School of Medicine, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
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