University of Department of Family and Community Medicine and Department of Pharmacy, St. Michael's Hospital, Toronto, Ontario, Canada.
Ann Pharmacother. 2010 Apr;44(4):740-5. doi: 10.1345/aph.1M579. Epub 2010 Mar 16.
To report 3 cases of immediate hypersensitivity reactions to moxifloxacin in patients who tolerated ciprofloxacin.
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.
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.
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.
报告 3 例对莫西沙星过敏而对环丙沙星耐受的患者的即刻过敏反应。
1 例 71 岁男性、1 例 44 岁女性和 1 例 70 岁女性在我院药物安全诊所口服莫西沙星后发生即刻过敏反应。反应主要表现为瘙痒和荨麻疹，尽管第一例和第二例患者分别出现呼吸困难和低血压。2 例患者口服环丙沙星的口服挑战试验阴性，所有 3 例患者均耐受口服环丙沙星的完整疗程。在所有 3 例中，使用 Naranjo 概率量表表明药物不良反应的可能性很高。
莫西沙星与其他氟喹诺酮类药物类似，可引起即刻过敏反应。以前的出版物报告了各种氟喹诺酮类药物之间的交叉反应和缺乏交叉反应。讨论的 3 例患者表现出莫西沙星和环丙沙星之间缺乏交叉反应，因为他们耐受口服挑战试验和完整的环丙沙星治疗疗程。莫西沙星在其双环环结构的 7 位和 8 位具有独特的侧链。双环环结构的 7 位和 8 位的特定侧链的抗原特异性可能解释了这种缺乏交叉反应的现象。与其他氟喹诺酮类药物相比，莫西沙星过敏反应的报告率较高，这可能与侧链特异性有关，尽管缺乏明确的证据。
根据我们的经验，如果患者先前耐受过完整的环丙沙星疗程，则在适当监测的情况下，对莫西沙星发生即刻过敏反应的患者可能会接受环丙沙星治疗。有必要研究是否存在莫西沙星特有的特定侧链反应。
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