Moxifloxacin in lower respiratory tract infections: in silico simulation of different bacterial resistance and drug exposure scenarios

Abstract

Moxifloxacin has potent bactericidal activity against Streptococcus pneumoniae; a major causative organism of lower respiratory tract infections. This study aims to use the pharmacokinetic/pharmacodynamic indices to predict the therapeutic outcome under different scenarios of moxifloxacin exposure and pneumococcal resistance. STELLA^® software was used to simulate the pharmacokinetics and pharmacodynamics of moxifloxacin in patients with severe pneumonia and acute exacerbations of chronic bronchitis (AECB). The current dose of moxifloxacin was found to be insufficient for eradication of ciprofloxacin resistant bacteria in ventilated patients with severe bronchopneumonia. This can be attributed to the lower tissue penetration observed in this population. Increasing the dose to 600 mg was able to achieve higher levels of free drug AUC/MIC in both bronchial and plasma compartments. In AECB, moxifloxacin achieved the same AUC/MIC values observed in pneumonia at the different MIC values. This may allow the extrapolation of findings of moxifloxacin studies in pneumonia to the management of patients with AECB.

Keywords:

• Moxifloxacin
• Pneumonia
• AECB
• Pharmacodynamics