Serum and ascitic fluid concentrations following a single IV dose of 400 mg moxifloxacin

Abstract number: r1922

Metallidis  S., Lazaraki  G., Tsona  A., Koumentaki  E., Alexiadou  E., Nikolaidis  J., Gogou  V., Chatzidimitriou  M., Gikas  A., Nikolaidis  P.

Objectives: 

Ascitic fluid is a favourable milieu for bacterial proliferation. Consequently, spontaneous bacterial peritonitis is not an uncommon complication in patients with ascites. A variety of pathogens have been implicated, the most common being Escherichia coli and Streptococci. So we estimated the concentrations of moxifloxacin, a new quinolone with activity against gram-negative and gram-positive (especially streptococci), into serum and ascitic fluid in patients with ascites and cirrhosis.

Methods: 

Six patients with decompecated cirrhosis and ascites were enrolled to the study. The Ethics committee of the hospital approved the study and all patients gave written consent. Patients were given a single 400 mg of moxifloxacin as a 60 min IV infusion and 2 hours after the end of infusion blood and ascetic fluid samples were collected. Samples were assayed for the presence of moxifloxacin by a high-performance liquid chromatography (HPLC) method.

Results: 

Following a single 400 mg infusion of moxifloxacin, mean serum concentration for the six patients was 4.29 mg/L (range 3.9–5.9 mg/L) 2 hours after the end of infusion. The concentration of moxifloxacin into ascetic fluid at the same time was 3.05 mg/L (range 2.6–4 mg/L). The penetration of moxifloxacin into ascetic fluid was 71.1%.

Conclusion: 

The levels that were achieved in the ascites are well above the MICs for E. coli (0.016 mg/L) and other members of the family Enterobacteriaceae, such as Proteus mirabilis and Klebsiella pneumoniae (0.03 mg/L). On the basis of the present findings of high levels of moxifloxacin in ascitic fluid and the excellent in vitro activity against members of the family Enterobacteriaceae, this fluroquinolone appears to be very promising for the treatment of spontaneous bacterial peritonitis.