Are moxifloxacin and levofloxacin equally effective to treat XDR tuberculosis
2017
Abstract :
Moxifloxacinretains partial activity against some fluoroquinolone-resistant mutants of Mycobacterium tuberculosis .
Levofloxacinis presumed to be as active as
moxifloxacinagainst drug-susceptible tuberculosis and to have a better safety profile. : To compare the in vivo activity of
levofloxacinand
moxifloxacinagainst M. tuberculosis strains with various levels of fluoroquinolone resistance. BALB/c mice were intravenously infected with 10 6 M. tuberculosis H37Rv and three isogenic mutants: GyrA A90V, GyrB E540A and GyrB A543V. Treatment with 50 or 100 mg/kg
levofloxacinand 60 or 66 mg/kg
moxifloxacinwas given orally every 6 h, for 4 weeks. :
Levofloxacin50 and 100 mg/kg q6h and
moxifloxacin60 and 66 mg/kg q6h generated AUCs in mice equivalent to those of
levofloxacin750 and 1000 mg/day and
moxifloxacin400 and 800 mg/day, respectively, in humans.
Moxifloxacin60 and 66 mg/kg q6h had bactericidal activity against strain H37Rv (MIC ≤ 0.25 mg/L) and mutants GyrB E540A and GyrB A543V (MIC = 0.5 mg/L). Against mutant GyrA A90V (MIC = 2 mg/L),
moxifloxacin60 mg/kg q6h did not prevent bacillary growth, whereas 66 mg/kg q6h had bacteriostatic activity.
Levofloxacin50 mg/kg q6h had bactericidal activity against H37Rv (MIC ≤ 0.25 mg/L) but not against the mutant strains.
Levofloxacin100 mg/kg q6h had bactericidal activity against H37Rv and mutants GyrB E540A (MIC = 0.5 mg/L) and GyrB A543V (MIC= 1 mg/L) but not against mutant GyrA A90V (MIC = 4 mg/L). : All mutations reduced fluoroquinolone activity, even those classified as susceptible according to phenotypic tests. High-dose
levofloxacinis less effective than high-dose
moxifloxacinagainst both fluoroquinolone-resistant and -susceptible M. tuberculosis strains in mice.
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