JAC Advance Access originally published online on September 4, 2009
Journal of Antimicrobial Chemotherapy 2009 64(5):1091-1095; doi:10.1093/jac/dkp318
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Original research |
Tissue penetration of moxifloxacin into human gallbladder wall in patients with biliary tract infections
1 Pharmacy Department, University Hospital of Heidelberg, Im Neuenheimer Feld 670, D-69120 Heidelberg, Germany 2 Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany 3 Hospital Bietigheim-Bissingen, Riedstr. 12, D-74321 Bietigheim-Bissingen, Germany 4 Department of Medical Microbiology and Hygiene, Institute of Hygiene, University of Heidelberg, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany 5 Department of Anaesthesiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany 6 Department of Gastroenterology and Hepatology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, D-69129 Heidelberg, Germany
Received 9 January 2009; returned 28 February 2009; revised 21 July 2009; accepted 5 August 2009
* Corresponding author. Tel: +49-6221-56-6762; Fax: +49-6221-56-5343; E-mail: stefanie.swoboda{at}med.uni-heidelberg.de
Objectives: Moxifloxacin, the newest fourth-generation fluoroquinolone, has a broad spectrum of antibacterial activity covering both Gram-positive and Gram-negative aerobic and anaerobic bacteria and is therefore very well suited for the treatment of biliary tract infections. The present study aimed to determine the penetration of moxifloxacin into gallbladder tissue to evaluate its antibiotic potential in this indication.
Patients and methods: Hospitalized patients with acute cholecystitis received a single, 1 h infusion of 400 mg of moxifloxacin before cholecystectomy. Serum and gallbladder wall tissue samples were collected during surgery, and the moxifloxacin concentrations were measured by HPLC.
Results: Sixteen patients (eight men and eight women) were included between January 2007 and April 2008. The time between start of infusion and gallbladder removal ranged from 50 min to 21 h 10 min. The serum concentration at the time of cholecystectomy was between 0.39 and 4.37 mg/L, and the tissue concentration between 1.73 and 17.08 mg/kg. The tissue-to-serum concentration ratio ranged from 1.72 to 6.33.
Conclusions: The results show that moxifloxacin penetrates well into gallbladder tissue and is therefore a therapeutic option for biliary tract infection. The highest concentrations in serum and gallbladder tissue were measured shortly after the end of a 1 h infusion. As perioperative prophylaxis, moxifloxacin should therefore be administered 30–60 min before the first surgical incision.
Keywords: tissue concentration , perioperative prophylaxis , surgery