title: Neither moxifloxacin nor cefuroxime produces significant attenuation of inflammatory mediator release in patients exposed to cardiopulmonary bypass: a randomized controlled trial.
abstract: OBJECTIVE
  In vitro and experimental studies in animals have established the anti-inflammatory effects of moxifloxacin. Cardiopulmonary bypass (CPB) leads to an inflammatory response. The aim of this study was to assess whether the inflammatory cytokine response to CPB is reduced with a perioperative antibiotic prophylaxis, either moxifloxacin or cefuroxime (the standard prophylaxis).
  
  
  METHODS
  Twenty-eight patients scheduled for elective coronary artery bypass grafting with CPB were randomly assigned to receive either moxifloxacin or cefuroxime as the perioperative antibiotic prophylaxis. Interleukin (IL)-6, -8, -10 and tumour necrosis factor-α (TNF-α) serum concentrations were determined at eight time points before and after CPB.
  
  
  RESULTS
  In both groups, all cytokine concentrations significantly increased after the start of CPB. There were no statistically significant differences between the moxifloxacin and cefuroxime groups at any point; IL-6 concentrations [median (interquartile range)] 240 min after CPB, the primary endpoint, were 364 (192-598) and 465 (325-906) pg/mL (P = 0.323), respectively.
  
  
  CONCLUSIONS
  Neither moxifloxacin nor cefuroxime produced significant attenuation of the inflammatory cytokine response to CPB. The reasons why moxifloxacin did not have significant anti-inflammatory effects in this unique clinical situation may be: (i) the inflammatory response to CPB may be different from that of infectious disease states that were used to establish the immunomodulatory effects of moxifloxacin; and (ii) a single intravenous dose, which was used in this investigation, may not lead to high enough plasma and intracellular concentrations.
authors.affiliation: Institute of Anaesthesiology, German Heart Centre Munich, Lazarettstr. 36, D-80636 Munich, Germany. wiesner@dhm.mhn.de
authors.forename: Gunther
authors.initials: G
authors.lastname: Wiesner
authors.forename: Siegmund-Lorenz
authors.initials: SL
authors.lastname: Braun
authors.forename: Michael
authors.initials: M
authors.lastname: Gruber
authors.forename: Ralph
authors.initials: R
authors.lastname: Gertler
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.forename: Peter
authors.initials: P
authors.lastname: Tassani
authors.forename: Klaus
authors.initials: K
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000494:pharmacology; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000494:pharmacology; D019072:Antibiotic Prophylaxis / Q000379:methods; D001372:Aza Compounds / Q000008:administration & dosage* / Q000494:pharmacology; D002315:Cardiopulmonary Bypass; D002444:Cefuroxime / Q000008:administration & dosage* / Q000494:pharmacology; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D011804:Quinolines / Q000008:administration & dosage* / Q000494:pharmacology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D001372:Aza Compounds; D016207:Cytokines; D024841:Fluoroquinolones; D007155:Immunologic Factors; D011804:Quinolines; D002444:Cefuroxime; D000077266:Moxifloxacin