From the Guidelines
Amikacin is preferred over moxifloxacin for the treatment of hospital-acquired pneumonia in the ICU, especially when there is a risk of multidrug-resistant organisms, due to its enhanced efficacy against non-fermenting Gram-negative bacilli, as suggested by experts in the field 1. When considering the choice between amikacin and moxifloxacin, several factors come into play, including the suspected pathogen, site of infection, local resistance patterns, and patient-specific factors such as renal function and administration route requirements.
- Amikacin is an aminoglycoside with excellent coverage against gram-negative bacteria, including Pseudomonas aeruginosa, Acinetobacter, Enterobacter, E. coli, Klebsiella, and Serratia, making it a suitable option for hospital-acquired pneumonia in the ICU.
- Moxifloxacin, on the other hand, is a fourth-generation fluoroquinolone with broader spectrum activity, covering many gram-positive bacteria, gram-negative bacteria, and some anaerobes, but its use may be limited by concerns of resistance and harm.
- The most recent guidelines recommend favouring the use of aminoglycosides over fluoroquinolones to limit the emergence of multidrug-resistant bacteria, and amikacin is preferred over gentamicin due to its enhanced efficacy against non-fermenting Gram-negative bacilli 1.
- Additionally, moxifloxacin has been recommended as an alternative option for the treatment of community-acquired pneumonia, but its use should be guided by local resistance patterns and patient-specific factors 1.
- A more recent study highlights the importance of considering local resistance patterns and patient-specific factors when choosing between antibiotics, and recommends amikacin as a first-line option for the treatment of hospital-acquired pneumonia in the ICU 1.
From the Research
Amikacin Coverage
- Amikacin is very active against most gram-negative bacteria, including gentamicin- and tobramycin-resistant strains 2
- It is effective in the treatment of serious gram-negative bacillary infections, particularly when resistance to gentamicin is a problem 3, 4
- Amikacin exhibits impressive in vitro synergy against aminoglycoside-sensitive and -resistant organisms when used in combination with beta-lactam antibiotics 2
Moxifloxacin Coverage
- There is no information available in the provided studies regarding moxifloxacin coverage
Comparison of Amikacin and Moxifloxacin
- Due to the lack of information on moxifloxacin in the provided studies, a direct comparison between amikacin and moxifloxacin coverage cannot be made
- Amikacin has been shown to be effective against a wide range of gram-negative bacteria, including those resistant to gentamicin and other aminoglycosides 2, 3, 4
Adverse Reactions
- Amikacin has been associated with nephrotoxicity and ototoxicity, although the potential for these adverse reactions is not significantly different from that of gentamicin or tobramycin 2, 5, 6
- The incidence of adverse reactions, including nephrotoxicity and ototoxicity, was similar between once-daily and twice-daily amikacin regimens 5