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Moxifloxacin pharmacokinetics and pleural fluid penetration in patients with pleural effusion
Kalliopi Chatzika1, Katerina Manika, Paschalina Kontou
1Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Thessaloniki, Greece.
Abstract:
The aim of this study was to evaluate the pharmacokinetics and penetration of moxifloxacin (MXF) in patients with various types of pleural effusion. Twelve patients with empyema/parapneumonic effusion (PPE) and 12 patients with malignant pleural effusion were enrolled in the study. A single-dose pharmacokinetic study was performed after intravenous administration of 400 mg MXF. Serial plasma (PL) and pleural fluid (PF) samples were collected during a 24-h time interval after drug administration. The MXF concentration in PL and PF was determined by high-performance liquid chromatography, and main pharmacokinetic parameters were estimated. Penetration of MXF in PF was determined by the ratio of the area under the concentration-time curve from time zero to 24 h (AUC24) in PF (AUC24PF) to the AUC24 in PL. No statistically significant differences in the pharmacokinetics in PL were observed between the two groups, despite the large interindividual variability in the volume of distribution, clearance, and elimination half-life. The maximum concentration in PF (CmaxPF) in patients with empyema/PPE was 2.23±1.31 mg/liter, and it was detected 7.50±2.39 h after the initiation of the infusion. In patients with malignant effusion, CmaxPF was 2.96±1.45 mg/liter, but it was observed significantly earlier, at 3.58±1.38 h (P<0.001). Both groups revealed similar values of AUC24PF (31.83±23.52 versus 32.81±12.66 mg·h/liter). Penetration of MXF into PF was similarly good in both patient groups (1.11±0.74 versus 1.17±0.39). Despite similar plasma pharmacokinetics, patients with empyema/parapneumonic effusion showed a significant delay in achievement of PF maximum MXF levels compared to those with malignant effusion. However, in both groups, the degree of MXF PF penetration and the on-site drug exposure, expressed by AUC24PF, did not differ according to the type of pleural effusion.
Insights
Moxifloxacin (MXF) shows good penetration into pleural fluid (PF) in both empyema and malignant effusions. Despite differences in achieving peak concentrations, overall drug exposure in PF was similar across effusion types.
Area of Science:
- Pharmacology
- Infectious Diseases
- Pulmonology
Background:
- Pleural effusion management requires effective antimicrobial penetration.
- Moxifloxacin (MXF) is a fluoroquinolone with broad-spectrum activity.
- Understanding MXF pharmacokinetics in pleural fluid (PF) is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate the pharmacokinetics and pleural fluid penetration of moxifloxacin (MXF).
- To compare MXF behavior in empyema/parapneumonic effusion (PPE) versus malignant pleural effusion.
- To assess the drug exposure within the pleural space.
Main Methods:
- Single-dose intravenous administration of 400 mg MXF to 24 patients (12 PPE, 12 malignant effusion).
- Serial collection of plasma (PL) and pleural fluid (PF) samples over 24 hours.
- High-performance liquid chromatography (HPLC) for MXF concentration determination and pharmacokinetic parameter estimation.
Main Results:
- No significant differences in plasma pharmacokinetics between effusion types.
- Malignant effusion group achieved maximum PF concentration (CmaxPF) significantly faster than PPE group.
- Both groups demonstrated similar area under the concentration-time curve in PF (AUC24PF) and good MXF penetration into PF.
Conclusions:
- Moxifloxacin exhibits comparable penetration and drug exposure in both empyema/PPE and malignant pleural effusions.
- While time to peak concentration differs, overall efficacy is likely similar due to sustained drug levels.
- MXF is a viable treatment option for infections associated with various pleural effusion types.
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