| Immediate hypersensitivity to moxifloxacin with tolerance to ciprofloxacin: report of three cases and review of the literature. | |
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MedLine Citation:
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PMID: 20233910 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To report 3 cases of immediate hypersensitivity reactions to moxifloxacin in patients who tolerated ciprofloxacin. CASE SUMMARIES: A 71-year-old man, a 44-year-old woman, and a 70-year-old woman with a history of a moxifloxacin reaction developed an immediate hypersensitivity reaction upon oral challenge with moxifloxacin in our Drug Safety Clinic. The reaction was mainly characterized by pruritus and urticaria, although dyspnea and hypotension were noted in the first and second patient, respectively. Two of the patients had negative oral challenge tests with ciprofloxacin and all 3 patients tolerated full treatment courses of oral ciprofloxacin. In all 3 cases, use of the Naranjo probability scale indicated a highly probable adverse drug reaction. DISCUSSION: Moxifloxacin, similar to other fluoroquinolones, can cause immediate hypersensitivity reactions. Previous publications have reported both cross-reactivity and a lack of cross-reactivity among various fluoroquinolones. The 3 patients discussed demonstrated a lack of cross-reactivity between moxifloxacin and ciprofloxacin since they tolerated oral challenge tests and full treatment courses of ciprofloxacin. Moxifloxacin has unique side chains at positions 7 and 8 on its bicyclic ring structure. Antigenic specificity to particular side chains at positions 7 and 8 on the bicyclic ring structure of moxifloxacin may explain this lack of cross-reactivity. Higher reporting rates of anaphylaxis to moxifloxacin compared to other fluoroquinolones may also be related to side chain specificity, although definitive evidence for this is lacking. CONCLUSIONS: Based on our experience, patients who develop immediate hypersensitivity reactions to moxifloxacin may receive ciprofloxacin therapy in an appropriately monitored setting if they have previously tolerated full treatment courses of ciprofloxacin. Research into whether there is a specific side chain reaction unique to moxifloxacin is warranted. |
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Authors:
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Brenda Chang; Sandra R Knowles; Elizabeth Weber |
Publication Detail:
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Type: Case Reports; Journal Article Date: 2010-03-16 |
Journal Detail:
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Title: The Annals of pharmacotherapy Volume: 44 ISSN: 1542-6270 ISO Abbreviation: Ann Pharmacother Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-25 Completed Date: 2010-06-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9203131 Medline TA: Ann Pharmacother Country: United States |
Other Details:
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Languages: eng Pagination: 740-5 Citation Subset: IM |
Affiliation:
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University of Department of Family and Community Medicine and Department of Pharmacy, St. Michael's Hospital, Toronto, Ontario, Canada. changb@smh.toronto.on.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-Bacterial Agents / adverse effects*, therapeutic use Aza Compounds / adverse effects*, therapeutic use Bronchiectasis / drug therapy Ciprofloxacin / adverse effects*, therapeutic use Drug Eruptions / diagnosis, pathology* Drug Hypersensitivity / diagnosis, pathology* Female Humans Hypersensitivity, Immediate / diagnosis, pathology* Male Middle Aged Quinolines / adverse effects*, therapeutic use Skin Tests Urticaria / etiology |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 0/Aza Compounds; 0/Quinolines; 0/moxifloxacin; 85721-33-1/Ciprofloxacin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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