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Penetration of moxifloxacin into bone in patients undergoing total knee arthroplasty
L Malincarne1, M Ghebregzabher, M V Moretti
1Department of Experimental Medicine and Biochemical Science, Section of Infectious Diseases, University of Perugia, Perugia, Italy.
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.
Insights
This study evaluated moxifloxacin levels in plasma and bone after single or double oral doses. Double dosing achieved bone concentrations effective against osteomyelitis pathogens.
Area of Science:
- Pharmacokinetics
- Infectious Diseases
- Orthopedic Surgery
Background:
- Osteomyelitis treatment requires antibiotics with excellent bone penetration.
- Fluoroquinolones are commonly used for bone infections.
- Moxifloxacin's efficacy in bone tissue needs further investigation.
Purpose of the Study:
- To determine plasma and bone concentrations of moxifloxacin.
- To assess the impact of single versus double oral dosing on drug levels.
- To evaluate moxifloxacin's potential for treating osteomyelitis.
Main Methods:
- Thirty patients undergoing total knee arthroplasty were divided into three groups.
- Groups received moxifloxacin 400 mg orally at different preoperative time points (single or double dose).
- Plasma, cortical bone, and cancellous bone samples were collected during surgery for moxifloxacin concentration measurement via HPLC.
Main Results:
- Mean plasma concentrations ranged from 3.45 to 6.26 mg/L.
- Mean cancellous bone concentrations ranged from 1.81 to 2.97 mg/L.
- Mean cortical bone concentrations ranged from 1.43 to 2.54 mg/L, with double dosing yielding higher levels.
Conclusions:
- Moxifloxacin demonstrates good penetration into both cortical and cancellous bone.
- Double oral dosing of moxifloxacin resulted in bone concentrations exceeding the MIC90 for common osteomyelitis pathogens.
- These findings support moxifloxacin's potential therapeutic role in osteomyelitis treatment.
