Plasma and Abscess Fluid Pharmacokinetics of Cefpirome and Moxifloxacin After Single and Multiple Dose Administration
Plasma and Abscess Fluid Pharmacokinetics of Cefpirome and Moxifloxacin After Single and Multiple Dose Administration
Penetration of cefpirome and moxifloaxacin into abscess fluid of humans will be tested.
 Patients with an abscess scheduled for drainage will receive study drugs (single or multiple
 dose), pus samples and plasma samples will be collected and analyzed by High pressure liquid
 chromatography (HPLC). Pharmacokinetics of the study drugs in pus and plasma will be
 determined using a pharmacokinetic model.
Title: Plasma and abscess fluid pharmacokinetics of cefpirome and moxifloxacin single dose
 and multiple dose administration.

 Background: Extensive research in the field of abscess treatment has established a claim for
 invasive drainage as the most efficient means of resolving suppurative lesions. In
 particular, computer tomography-guided percutaneous abscess drainage has repeatedly been
 reported to be advantageous compared to other invasive methods. However, application of the
 percutaneous interventional method is subject to some limitations. Coagulation abnormalities
 are considered a contraindication, and the absence of a safe anatomic access route, the
 presence of fistulas, severe inflammation of organs, or patients with advanced age have
 likewise been linked to low success rates of percutaneous abscess drainage. From these
 considerations, it becomes evident that percutaneous and surgical abscess drainage alone are
 not satisfactory in a number of patients suffering from abscess/infected cyst-related
 disease. In some patients antibiotic therapy is administered in bridging them to more stable
 conditions that drainage can be performed. Therefore, it is eminent for the overall outcome
 of patients to select an appropriate antibiotic. For this purpose, a model was recently
 developed to simulate the concentration time-curve of fosfomycin in abscess fluid after a
 single dose and after multiple doses.

 Cefpirome and moxifloxacin are drugs which may be used in the empiric therapy of purulent
 infections. They may be used as monotherapy or they may be combined, e.g. with fosfomycin.
 Cefpirome is a 4th class cephalosporin with a broad spectrum (gram positive and gram negative
 pathogens), penetrating well into soft tissues. Moxifloxacin is a new fluoroquinolone with a
 considerable antimicrobial spectrum, also penetrating excellently into soft tissues. Based on
 the experiences with the methods and results obtained from our recent study on fosfomycin
 penetration into abscess fluid, the present pilot study will be set out to gain PK
 information on the penetration properties of cefpirome and moxifloxacin into abscess fluid
 and abdominal cysts.

 Aim of the study: To determine pharmacokinetics of cefpirome and moxifloxacin in abscess
 (cyst) fluid and plasma after single and multiple doses.

 Study design: Pharmacokinetic pilot study. Drug concentrations will be determined in abscess
 liquid upon drainage and in plasma over a period of eight hours.

 Study population: 20 Patients with an abscess or an abdominal cyst, scheduled for surgical or
 computer tomography-guided drainage.

 Methods: 1) High pressure liquid chromatography 2) Analysis of computer tomography (CT)
 images 3) Pharmacokinetic simulation model

 Study drugs: Cefpirome (Cefrom, Aventis): will be administered to patients intravenously as
 single or multiple doses of 2 g dissolved in 100 mL of distilled water over 20 minutes.
 Moxifloxacin (Avelox, Bayer): will be administered to patients per os as tablet as single or
 multiple doses of 400 mg.

 Patients: A total of 20 patients will be enrolled in the study. They will be assigned to 2
 groups. Group 1: single dose (n = 12), Group 2: multiple doses (n = 8).

 Main outcome variable: The cefpirome and moxifloxacin concentrations in abscess fluid will be
 measured. Considering plasma PK and the ratio of the surface to volume ratio of the abscess,
 the individual concentration-versus-time curve in abscess (cyst) fluid will be calculated.
 Individual pharmacokinetic parameters will be determined for abscess (cyst) fluid after a
 single dose and at steady state: AUC, AUC0-12/24h, Cmax, Tmax, t1/2ß, Cav(ss).

 Additional outcome variables: Plasma (single dose and steady state): AUC, AUC0-12/24h, Cmax,
 Tmax, t1/2ß, Cav(ss). Pus and plasma: ratios of AUC and Cav(ss) to MIC, T>MIC The following
 parameters will be determined if possible: the diameter of the pericapsular space with
 enrichment of contrast agent, the degree of contrast agent enhancement in this zone and the
 pus density, rate of drug degradation in pus at body temperature in vitro, pH-value of pus,
 pus viscosity and specific weight.

 Inconveniences and risks for patients:

 The following side effects may occur after administration of cefpirome: Hypersensitivity
 reaction, allergic skin reactions, exanthema, urticaria, pruritus, drug fever, anaphylactic
 reactions, anaphylactic shock, interstitial nephritis, nausea, vomiting, abdominal pain,
 diarrhoea, pseudomembraneous colitis, elevation of liver enzymes and serum creatinine,
 thrombocytopenia, eosinophilia, hemolytic anemia, granulocytopenia, agranulocytosis, local
 irritation and pain at the site of injection, dysgeusia.

 The following side effects may occur after administration of moxifloxacin:

 Often or occasionally: Nausea, diarrhea, vomits, dyspepsia, QT-prolongation, elevation of
 AST, ALT, bilirubin, gamma GT, amylase, leucocytopenia, decrease of prothrombin,
 eosinophilia, thrombocythemia, thrombocytopenia, anemia, abdominal and head pain, dizziness,
 dysgeusia; unfrequent: asthenia, candidosis, thoracal and back pain, discomfort, leg pain,
 anaphylactic reactions, anaphylactic shock, insomnia, vortex, nervousness, tremor,
 paresthesia, discomposure, depression, hallucination, depersonalization, ataxia, xerostomia,
 flatulence, obstipation, anorexia, stomatitis, glossitis, tachycardia, edema, hypertension,
 palpitations, QT-prolongation, syncope, atrial fibrillation, angina pectoris, vasodilatation,
 hypotension, ventricular arrhythmia, torsade de pointe, hyperglycemia, hyperlipidemia,
 elevation of prothromin, icterus, arthralgia, myalgia, tendonitis, rash, pruritus,
 perspiration, urticaria, xerodermia, amblyopia, tinnitus, vaginitis, hepatitis, ataxia,
 tendon rupture, hypernatremia, hypercalcemia, neutropenia, hemolysis, transient loss of
 vision.

 Total blood loss will be limited to a maximum of 85 mL, which is usually well tolerated by
 patients.

 Risk/benefit assessment: CT and abscess drainage represent standard diagnosis and therapeutic
 procedures. Therefore, any risk associated with CT or abscess drainage is not ascribed to
 study procedures. Single and multiple doses of cefpirome (maximum of 14 doses) and
 moxifloxacin (maximum of 7 doses) are normally well tolerated and have very few side effects.

 Ongoing therapy will not be affected or changed by study procedures. In summary, the risk
 conferred to patients by study procedures appears minimal.
Inclusion Criteria:

 -  Female or male, aged between 18 and 90 years.

 -  Written informed consent.

 -  Abscess formation or abdominal cyst scheduled to drainage.

 -  Plasma creatinine <1.5 mg/dL

 Exclusion Criteria:

 -  Pregnancy or lactation.

 -  Hemodialysis or hemofiltration

 -  Allergy or hypersensitivity against study drugs

 -  Massive edemata or hypernatremia

 -  Reduced liver function (Child-Pugh A, B, C)

 -  Relevant prolongation of QT-interval

 -  CNS-diseases which predispose for cramps