Journal of Antimicrobial Chemotherapy (2002) 49, 821-826
© 2002 The British Society for Antimicrobial Chemotherapy
A prospective, multicentre study of moxifloxacin concentrations in the sinus mucosa tissue of patients undergoing elective surgery of the sinus
1Otorhinolaryngology Unit, Bichat Claude-Bernard Hospital, 75877 Paris; 2General Hospital, 21033 Dijon; 3CH Lyon Sud, 69495 Pierre-Benite; 4Jean Minjoz Hospital, 25030 Besancon; 5CH Bicêtre, 94275 Le Kremlin Bicetre; 6CH Leon Touhladjian, 78303 Poissy; 7Les Hospitalières Clinic, 86000 Poitiers; 8Bayer Pharma, 92807 Puteaux, France; 9Pharma Research Centre, Bayer AG, 42096 Wuppertal, Germany
Received 21 June 2001; returned 30 September 2001; revised 2 January 2002; accepted 27 January 2002.
A pharmacokinetic study was carried out to determine moxifloxacin concentrations in sinus tissue, after oral moxifloxacin 400 mg once daily for 5 days to patients with chronic sinusitis, undergoing elective sinus surgery. Patients were randomly allocated to one of seven treatment groups, in which tissues were sampled 2, 3, 4, 6, 12, 24 or 36 h post-dose. A control group with non-infected nasal polyps was also included. Forty-eight patients (13 female, 35 male, mean age 47.1 years) were allocated to one of each active treatment group (n = 42) or to the control group (n = 6). Tissue and plasma samples were taken simultaneously and stored frozen until assayed by HPLC. Thirty-nine patients were fully valid for pharmacokinetic analysis. The geometric mean moxifloxacin plasma concentration increased from 2.32 mg/L at 2 h to a maximum of 3.37 mg/L at 4 h post-dose, decreasing to 0.37 mg/L at 36 h post-dose. The moxifloxacin concentration in sinus mucosa was consistently greater than that in plasma being 4.56–5.73 mg/kg from 2 to 6 h and 2.81–1.25 mg/kg from 12 to 36 h post-dose. The elimination rates in plasma and sinus tissues were similar. The tissue/plasma ratio was c. 200% between 2 and 6 h, and up to 328.9% at 36 h. Results were similar whatever the site of tissue sampling (maxillary sinus, anterior ethmoid sinus or nasal polyps). Tissue levels exceeded the MIC90 of all pathogens commonly causing acute sinusitis (e.g. 5–30 x MIC for Streptococcus pneumoniae: 0.25 mg/L). These results sup-port the use of moxifloxacin 400 mg once daily as a regimen for the treatment of sinus infections.
* Correspondence address. Bayer Pharma, Medical Affairs Department, 13 rue Jean Jaurès, 92807 Puteaux Cedex, France. Tel: +33-1-49065779; Fax: +33-1-49063610; E-mail: pierre.arvis.pa{at}bayer-ag.de
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