Maternal blood and amniotic fluid levels of moxifloxacin, levofloxacin and cefixime.
OBJECTIVE
Moxifloxacin and levofloxacin are wide spectrum quinolones and cefixime is a third-generation cephalosporin with a wider spectrum of activity against gram-positive and gram-negative bacteria and anaerobics. Although they are widely used, little is known about the amniotic fluid levels of these antibiotics. The aim of the present investigation was to study and compare the maternal blood and amniotic fluid levels of these antibiotics in second trimester pregnancy.


METHODS
To assess the amniotic fluid levels of these antibiotics, 10 pregnant women were given moxifloxacin, 10 were given levofloxacin and 6 were given cefixime orally 2 h before amniocentesis as a single dose for prophylaxis. During amniocentesis, an extra 2 mL amniotic fluid sample and 2 mL maternal venous blood were drawn. The levels of these agents in samples were analyzed using high performance liquid chromatography.


RESULTS
The amniotic fluid levels of moxifloxacin and levofloxacin were 0.27 +/- 0.21 microg/mL and 0.60 +/- 0.41 microg/mL, respectively. The maternal blood levels were 3.53 +/- 0.65 microg/mL and 3.95 +/- 0.77 microg/mL in the moxifloxacin and levofloxacin groups, respectively. The maternal blood level of cefixime was 2.59 +/- 1.10 microg/mL and the amniotic fluid level was 0.85 +/- 0.42 microg/mL. The amniotic fluid passage rates were 7.83% for moxifloxacin, 15.67% for levofloxacin and 37.55% for cefixime.


CONCLUSIONS
Of these three antibiotics, cefixime has the highest transplacental passage rate and, therefore, can be used as a therapeutic agent in infectious conditions in which membranes and the placenta are involved. Moxifloxacin and levofloxacin have low passage rates, which should be considered when using as a therapeutic agent.
Ozyüncü
Ozgür
O
Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey. ozyuncu@hacettepe.edu.tr
Beksac
Mehmet Sinan
MS
Nemutlu
Emirhan
E
Katlan
Doruk
D
Kir
Sedef
S
D000328:Adult; D000649:Amniocentesis; D000653:Amniotic Fluid / Q000737:chemistry*; D000900:Anti-Bacterial Agents / Q000032:analysis / Q000097:blood / Q000627:therapeutic use; D001372:Aza Compounds / Q000032:analysis* / Q000097:blood* / Q000627:therapeutic use; D020682:Cefixime / Q000032:analysis* / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D064704:Levofloxacin; D000077266:Moxifloxacin; D015242:Ofloxacin / Q000032:analysis* / Q000097:blood* / Q000627:therapeutic use; D011247:Pregnancy; D011804:Quinolines / Q000032:analysis* / Q000097:blood* / Q000627:therapeutic use; D018709:Statistics, Nonparametric
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D064704:Levofloxacin; D020682:Cefixime; D015242:Ofloxacin; D000077266:Moxifloxacin