Moxifloxacin distribution in the interstitial space of infected decubitus ulcer tissue of patients with spinal cord injury measured by in vivo microdialysis

Abstract

We investigated the distribution of moxifloxacin in the interstitial space of normal and infected subcutaneous tissue in patients with spinal cord injury and decubitus ulcers using in vivo microdialysis. Drug concentrations achieved in serum, saliva, normal and infected tissues showed approximately parallel time profiles. The interstitial tissue fluids reached bactericidal levels for common bacteria found in infected skin lesions. Our findings suggest that moxifloxacin exhibits good and similar penetration into the interstitial space fluid in normal subcutaneous tissue and infected decubitus ulcers in patients with spinal cord injury.

Antimicrobial Dosing Considerations in Obese Adult Patients

“…31 Numerous studies have applied microdialysis to assess interstitial concentrations, which may better predict activity against infections that affect the skin and skin structure and underlying tissue. 29,[32][33][34][35][36][37] Given the epidemiologic data supporting an increased risk of surgical site infection in obese patients, discussion of this issue is warranted. 5 Most clinical microdialysis studies have included subjects of normal weight and have evaluated interstitial concentrations from the subcutis, muscle, and adipose tissue.…”

“…5 Most clinical microdialysis studies have included subjects of normal weight and have evaluated interstitial concentrations from the subcutis, muscle, and adipose tissue. [32][33][34][35][36][37] The limited data in this population imply that the time to C max of hydrophilic antibiotics may be slightly delayed in these tissues relative to plasma. [32][33][34][35][36][37] In general, the concentration-time profiles of drugs like linezolid, ertapenem, telithromycin, ofloxacin, moxifloxacin, cefpodoxime, and cefixime reveal that interstitial concentrations can be approximated clinically based on protein binding.…”

“…[32][33][34][35][36][37] The limited data in this population imply that the time to C max of hydrophilic antibiotics may be slightly delayed in these tissues relative to plasma. [32][33][34][35][36][37] In general, the concentration-time profiles of drugs like linezolid, ertapenem, telithromycin, ofloxacin, moxifloxacin, cefpodoxime, and cefixime reveal that interstitial concentrations can be approximated clinically based on protein binding. [32][33][34][35][36][37] For example, ertapenem is 85-95% plasma protein bound, the mean AUC values after a 1-g infusion were 360 mg•hour/L (plasma), 40 mg•hour/L (muscle), and 19 mg•hour/L (subcutis).…”

“…[32][33][34][35][36][37] In general, the concentration-time profiles of drugs like linezolid, ertapenem, telithromycin, ofloxacin, moxifloxacin, cefpodoxime, and cefixime reveal that interstitial concentrations can be approximated clinically based on protein binding. [32][33][34][35][36][37] For example, ertapenem is 85-95% plasma protein bound, the mean AUC values after a 1-g infusion were 360 mg•hour/L (plasma), 40 mg•hour/L (muscle), and 19 mg•hour/L (subcutis). The muscle and subcutis ertapenem AUC values are reflective of the 5-15% estimated free ertapenem concentrations.…”

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

“…13 It is not, however, recommended against methicillin-resistant S. aureus (MRSA). Moxifloxacin has good tissue penetration 14,15 and iv to oral switch-down is simple, as the pharmacokinetic profiles for the two formulations are virtually interchangeable. 16,17 Its once-daily formulation makes it a convenient antimicrobial option.…”