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JAC Advance Access originally published online on February 27, 2006
Journal of Antimicrobial Chemotherapy 2006 57(4):789-792; doi:10.1093/jac/dkl050
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Concentration of moxifloxacin in plasma and tonsillar tissue after multiple administration in adult patients

Silvano Esposito1,*, Silvana Noviello1, Gioacchino D'Errico2, Gaetano Motta2, Desiderio Passali3, Claudia Aimoni4, Stefano Pilucchi4, Stefania Fallani5, Maria Iris Cassetta5, Teresita Mazzei5 and Andrea Novelli5

1 Dipartimento di Malattie Infettive, Seconda Università di Napoli, Italy; 2 Dipartimento di Otorinolaringoiatria, Seconda Università di Napoli, Italy; 3 Clinica Otorinolaringoiatrica, Università degli Studi di Siena, Italy; 4 Dipartimento di Discipline Medico Chirurgiche della Comunicazione e del Comportamento, Sez. ORL, Università degli Studi di Ferrara, Italy; 5 Istituto di Farmacologia Preclinica e Clinica, Università di Firenze, Italy

Received 2 March 2005; returned 20 May 2005; revised 9 September 2005; accepted 7 February 2006

* Correspondence address. Clinica Malattie Infettive, Ospedale Gesù e Maria, Seconda Università degli Studi di Napoli, Via D. Cotugno 1, 80135 Napoli, Italy. Tel: +39-081-5666218; Fax: +39-081-5666203; E-mail: silvanoesposito{at}libero.it

Objectives: The antibacterial spectrum of moxifloxacin includes all the major respiratory pathogens, and its pharmacokinetics demonstrate high peak concentrations in plasma as well as at respiratory sites. Nevertheless, tonsillar tissue concentrations have never been investigated. In this study we determined the moxifloxacin concentrations in plasma and tonsillar tissue after the administration of three doses of moxifloxacin 400 mg to adult patients with chronic or recurrent tonsillitis undergoing tonsillectomy.

Methods: This was an uncontrolled, open-label, randomized, parallel group study including 35 patients assigned randomly to five groups of 7 patients each, depending on the time between the last dose of moxifloxacin and plasma and tissue sampling. Moxifloxacin was given orally once daily for 3 days; its concentrations were measured using a validated HPLC assay and fluorescence detection. Each sample was analysed twice and the mean value obtained used for the statistical analysis. Pharmacokinetic data were analysed by presenting descriptive statistics of moxifloxacin concentrations in plasma and tonsillar tissue.

Results: Cmax occurred at 3 h in tonsillar tissue (mean 8.96 mg/L) and in plasma (mean 3.20 mg/L), the tissue/plasma concentration ratios (mean values) being constantly >2, ranging between 2.37 (after 2 h) and 2.93 (after 24 h), which indicates a prolonged maintenance of moxifloxacin concentration in tonsillar tissue compared with plasma. Variability among patients was present at 6 h, with the tonsillar tissue/plasma concentration ratio ranging between 0.8 and 3.4.

Conclusions: Moxifloxacin achieves a good penetration in tonsillar tissue, which compares favourably with that reported for other fluoroquinolones. The moxifloxacin concentrations we observed exceed the MICs for the usual respiratory tract pathogens.

Keywords: pharmacokinetics , fluoroquinolones , otorhinolaryngology


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