TY - JOUR T1 - Moxifloxacin in multidrug-resistant tuberculosis: is there any indication for therapeutic drug monitoring? JF - European Respiratory Journal JO - Eur Respir J SP - 1051 LP - 1053 DO - 10.1183/09031936.00202411 VL - 40 IS - 4 AU - Katerina Manika AU - Kalliopi Chatzika AU - Konstantinos Zarogoulidis AU - Ioannis Kioumis Y1 - 2012/10/01 UR - http://erj.ersjournals.com/content/40/4/1051.abstract N2 - To the Editors:Fluoroquinolones are rapidly emerging as important drugs in the treatment of tuberculosis (TB) worldwide [1]. In drug-susceptible TB, their use is currently under investigation and, according to the American Thoracic Society/Centers for Disease Control guidelines, fluoroquinolones are indicated only in patients receiving the conventional regimen who present severe adverse reactions [2]. However, in drug-resistant (DR) and, more specifically, in multidrug-resistant (MDR)-TB, the role of fluoroquinolones is much better established. Later-generation fluoroquinolones are included even in extensively drug resistant (XDR)-TB regimens since they may have some efficacy against ofloxacin-resistant strains [3].The area under the concentration–time curve up to 24 h post-dosage (AUC24) is generally considered as the best predictor of fluoroquinolone efficacy [1]. Among fluoroquinolones, moxifloxacin is considered the most bactericidal, with potency comparable to that of isoniazid, and also seems to have some sterilising activity [1]. The maximal concentration (Cmax) of moxifloxacin exceeds mutant prevention concentration [1] and the currently recommended dose of 400 mg is likely to suppress the emergence of resistance in 60% of patients [4]. However, pharmacokinetic data on moxifloxacin in patients with TB are scarce, especially in the setting of an MDR-TB regimen.In this report of a pilot prospective study, we present preliminary data on pharmacokinetic parameters in patients with MDR- or XDR-TB receiving second-line treatment. Patients were receiving moxifloxacin (Avelox®; Bayer, Leverkusen, Germany) p.o. for ≥4 days, in order to achieve a steady state, as part of their anti-TB treatment, which was based on drug susceptibility test results. Quinolone resistance was determined by ofloxacin … ER -