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JAC Advance Access published online on March 21, 2006
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkl091
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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
Received March 4, 2005
Revised June 28, 2005
Accepted February 24, 2006

Original article

Penetration of moxifloxacin into bone in patients undergoing total knee arthroplasty

L. Malincarne 1, M. Ghebregzabher 2, M. V. Moretti 1 *, A. M. Egidi 1, B. Canovari 1, G. Tavolieri 3, D. Francisci 1, G. Cerulli 1, and F. Baldelli 1

1 Department of Experimental Medicine and Biochemical Science, Section of Infectious Diseases, University of Perugia, Perugia, Italy
2 Department of Gynaecological, Obstetrical and Paediatric Sciences, Section of Paediatry, University of Perugia, Perugia, Italy
3 Department of Orthopaedics, University of Perugia, Perugia, Italy

* To whom correspondence should be addressed.
M. V. Moretti, E-mail: mavimoretti{at}yahoo.it


  Abstract

Objectives: To investigate plasma and bone moxifloxacin concentrations following oral administration of a single or double dose of the drug, in order to consider its potential role in the treatment of osteomyelitis.

Patients and methods: Thirty consecutive patients undergoing total knee arthroplasty were recruited. Three groups, of ten patients each, were formed: group A received moxifloxacin 400 mg orally 2 h (range 1.5-2.5) preoperatively, group B received moxifloxacin 400 mg orally 4 h (range 3.5-4.5) preoperatively and group C received moxifloxacin 400 mg orally 14 h preoperatively, followed by a second dose 2 h (range 1.5-2.5) preoperatively. During surgery, at the time of bone removal, a blood sample and aliquots of cortical and cancellous bone were collected and moxifloxacin concentrations were measured by HPLC.

Results: Mean plasma, cancellous bone and cortical bone concentrations were, respectively: 3.45, 1.89 and 1.43 mg/L for group A; 3.73, 1.81 and 1.56 mg/L for group B; and 6.26, 2.97 and 2.54 mg/L for group C.

Conclusions: These data show a good penetration of moxifloxacin into both cancellous and cortical bone, with concentrations, after double dosing, exceeding the MIC90 for most pathogens involved in osteomyelitis and the clinic susceptibility breakpoint for Mycobacterium tuberculosis.

Keywords: fluoroquinolones; cortical bone; cancellous bone; osteomyelitis.
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