Convulsions associated with moxifloxacin

Cone, Catherine; Horowitz, Bruce

doi:10.2146/ajhp130685

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…AUC 0-24 /MIC ratios of 25-30 may suffice for Gram-positive infections, 76,77 but higher exposures of $125 are reportedly necessary for Gram-negative infections. 30,78,80,81,138 Although increasing reports of fluoroquinolone-associated seizures have emerged, [139][140][141] toxicity thresholds are yet to be established, and causality remains debatable. 142 The use of AUC-based monitoring, which aims to achieve AUC 0-24 / MIC ratios of $80 (free concentrations) or $125 (total concentrations), seems appropriate when TDM is required for fluoroquinolones.…”

Section: Fluoroquinolonesmentioning

confidence: 99%

Therapeutic Drug Monitoring of Antibiotics: Defining the Therapeutic Range

Abdul‐Aziz

Brady

Cotta

et al. 2022

Therapeutic Drug Monitoring

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In the present narrative review, the authors aimed to discuss the relationship between the pharmacokinetic/ pharmacodynamic (PK/PD) of antibiotics and clinical response (including efficacy and toxicity). In addition, this review describes how this relationship can be applied to define the therapeutic range of a particular antibiotic (or antibiotic class) for therapeutic drug monitoring (TDM).Methods: Relevant clinical studies that examined the relationship between PK/PD of antibiotics and clinical response (efficacy and response) were reviewed. The review (performed for studies published in English up to September 2021) assessed only commonly used antibiotics (or antibiotic classes), including aminoglycosides, beta-lactam antibiotics, daptomycin, fluoroquinolones, glycopeptides (teicoplanin and vancomycin), and linezolid. The best currently available evidence was used to define the therapeutic range for these antibiotics. Results:The therapeutic range associated with maximal clinical efficacy and minimal toxicity is available for commonly used antibiotics, and these values can be implemented when TDM for antibiotics is performed. Additional data are needed to clarify the relationship between PK/PD indices and the development of antibiotic resistance.Conclusions: TDM should only be regarded as a means to achieve the main goal of providing safe and effective antibiotic therapy for all patients. The next critical step is to define exposures that can prevent the development of antibiotic resistance and include these exposures as therapeutic drug monitoring targets.

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Section: Fluoroquinolonesmentioning

confidence: 99%

Therapeutic Drug Monitoring of Antibiotics: Defining the Therapeutic Range

Abdul‐Aziz

Brady

Cotta

et al. 2022

Therapeutic Drug Monitoring

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“…For Gram-positive infections, a AUC0–24/MIC 25–30 target is recommended, contrary to the higher AUC/MIC >125 for GNB [ 113 , 114 ]. Pertinent adverse effects in the ICU setting include neurotoxicity (seizures, altered mental status), associated C. difficile infection, prolongation of QTc interval, and altered serum glucose control [ 107 , 115 , 116 , 117 ]. However, toxicity thresholds have not been specified [ 15 ].…”

Section: Antibiotics In the Icumentioning

confidence: 99%

Optimizing Antimicrobial Drug Dosing in Critically Ill Patients

et al. 2021

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A fundamental step in the successful management of sepsis and septic shock is early empiric antimicrobial therapy. However, for this to be effective, several decisions must be addressed simultaneously: (1) antimicrobial choices should be adequate, covering the most probable pathogens; (2) they should be administered in the appropriate dose, (3) by the correct route, and (4) using the correct mode of administration to achieve successful concentration at the infection site. In critically ill patients, antimicrobial dosing is a common challenge and a frequent source of errors, since these patients present deranged pharmacokinetics, namely increased volume of distribution and altered drug clearance, which either increased or decreased. Moreover, the clinical condition of these patients changes markedly over time, either improving or deteriorating. The consequent impact on drug pharmacokinetics further complicates the selection of correct drug schedules and dosing during the course of therapy. In recent years, the knowledge of pharmacokinetics and pharmacodynamics, drug dosing, therapeutic drug monitoring, and antimicrobial resistance in the critically ill patients has greatly improved, fostering strategies to optimize therapeutic efficacy and to reduce toxicity and adverse events. Nonetheless, delivering adequate and appropriate antimicrobial therapy is still a challenge, since pathogen resistance continues to rise, and new therapeutic agents remain scarce. We aim to review the available literature to assess the challenges, impact, and tools to optimize individualization of antimicrobial dosing to maximize exposure and effectiveness in critically ill patients.

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“…Состояниями, предрасполагающим к развитию судорог при назначении фторхинолонов, является черепно-мозговая травма (ЧМТ), инсульт, эпилепсия, менингит. Развитие судорог может быть спровоцировано одновременным назначением фторхинолонов с нестероидными противовоспалительными средствами (НПВС), фенитоином, производными нитроимидазола [9,17,27].…”

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“…Развитие психоза при приёме неомицина сульфата указывает на нейротоксическое действие препарата и требует немедленной его отмены и стационарного лечения развившего осложнения. Поражение нервной системы при лечении полимиксинами наблюдается у 80 % пациентов с заболеваниями почек, так как при этом происходит кумуляция препарата [1,9].…”

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Potential Risks in Modern Antibiotic Therapy

et al. 2021

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Knowledge of the safety profile of antibacterial drugs is important for rational pharmacotherapy with antibiotics. The purpose of this information is to help the doctor, pharmacist and patient to (quickly) "navigate" in the safety of antibiotics to implement one of the basic principles of pharmacotherapy "Do no harm!". The aim of the study. Analysis of possible potential risks in modern antibiotic therapy. Materials and methods. Analysis of data from the scientific literature on the side effects of antibiotics. Results. Most antibiotics have a wide spectrum of antimicrobial action, much less of them have a narrow spectrum of activity, but all of them have side effects (SE). In particular, the neurotoxicity of penicillins and fluoroquinolones is a consequence of their antagonism with GABA. The latter mechanism is also responsible for the neurotoxicity of carbapenens, monobactams and cephalosporins. Cardiotoxicity and hematotoxicity of benzylpenicillins are the result of inhibition of tissue respiration and the process of converting fibrinogen to fibrin, which causes bleeding. The hematotoxicity of carbopenicillins, monobactams and cephalosporins is associated with the inhibition of the conversion of vicasol (vit. K) into its active form, as well as the obstruction of its synthesis due to the suppression of normal intestinal microflora (the main producer of endogenous vit. K). The nephrotoxicity of aminoglycosides and vancomycin is associated with the accumulation of these drugs in the cells of the proximal renal tubules and impaired enzyme activity (Na+-, K+-, ATP; respiratory, etc.), which leads to interstitial nephritis. Ototoxicity of antibiotics is observed when they are used over the age of 60 – a factor that predisposes to ototoxicity. Conclusions. In order to conduct effective antibiotic therapy, it is very important to take into account the side effects that are characteristic of certain groups of antibiotics and each is representatively individual.

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Convulsions associated with moxifloxacin

Cited by 7 publications

References 12 publications

Therapeutic Drug Monitoring of Antibiotics: Defining the Therapeutic Range

Therapeutic Drug Monitoring of Antibiotics: Defining the Therapeutic Range

Optimizing Antimicrobial Drug Dosing in Critically Ill Patients

Potential Risks in Modern Antibiotic Therapy

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