International Journal of Antimicrobial Agents 36 (2010) 175–178 Contents lists available at ScienceDirect International Journal of Antimicrobial Agents journal homepage: http://www.elsevier.com/locate/ijantimicag Short communication Maternal and fetal blood levels of moxifloxacin, levofloxacin, cefepime and cefoperazone Ozgur Ozyuncu a,∗ , Emirhan Nemutlu b , Doruk Katlan a , Sedef Kir b , M. Sinan Beksac a a Hacettepe University, Faculty of Medicine, Department of Obstetrics and Gynecology, Maternal Fetal Medicine and Perinatology Unit, Sihhiye, Ankara, Turkey b Hacettepe University, Faculty of Pharmacy, Department of Analytical Chemistry, Sihhiye, Ankara, Turkey article info Article history: Received 9 November 2009 Accepted 8 March 2010 Keywords: Moxifloxacin Levofloxacin Cefepime Cefoperazone Antibiotics Fetal blood Maternal blood abstract Wide-spectrum quinolones such as moxifloxacin and levofloxacin as well as high-order cephalosporins such as cefoperazone and cefepime have increased antimicrobial activity. However, little is known about their distribution in fetal blood. Therefore, the aim of this study was to measure and compare maternal and fetal blood levels of these agents. For the measurement of blood levels, 9 pregnant women received cefepime hydrochloride, 10 received cefoperazone, 10 received moxifloxacin and 12 received levofloxacin intravenously. Maternal and umbilical cord blood samples were drawn during delivery. Antibiotic levels were analysed by high-performance liquid chromatography. Mean transplacental passage rates of moxi- floxacin, levofloxacin, cefepime and cefoperazone were 74.84%, 66.53%, 23.21% and 12.68%, respectively, and mean transfetal passage rates were 90.78%, 84.22%, 79.17% and 79.78%, respectively. The transpla- cental passage rate for either quinolone was significantly higher than that of either cephalosporin, and the transplacental passage rate of cefoperazone was lower than that of cefepime. In conclusion, both quinolones have high transplacental passage rates. Cefepime and cefoperazone have a lower transpla- cental passage rate and thus may be used as prophylaxis in situations where transplacental passage is undesirable. © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. 1. Introduction Caesarean section is known to be the most important risk factor for postpartum infections [1]. Women undergoing Caesarean deliv- ery have a 20-fold greater risk of postpartum infection compared with those undergoing vaginal delivery. Caesarean also increases the length of hospitalisation, which is also a risk factor for infec- tious morbidities. Major infectious morbidities following Caesarean delivery are fever, wound infection, endometritis, bacteraemia, uri- nary tract infections and other rarer and more serious infectious conditions such as pelvic abscess and septic shock [1,2]. When the high level of Caesarean rates is considered, morbidity and even mortality resulting from these infections may reach significant lev- els. Use of antibiotic prophylaxis has been observed to decrease these infectious morbidities. In a recent meta-analysis of ran- domised trials [2] it was reported that both in elective and non-elective situations, use of prophylactic antibiotics prior to Caesarean section significantly reduced the incidence of postpartum infectious morbidities. In another meta-analysis ∗ Corresponding author. Tel.: +90 312 305 2484; fax: +90 312 305 2315. E-mail address: ozyuncu@hacettepe.edu.tr (O. Ozyuncu). of 51 antibiotic trials [3] it was confirmed that use of first- generation cephalosporins and ampicillin had similar efficacy compared with wider-spectrum second- or third-generation cephalosporins. Based on these findings and the increased inci- dence of ampicillin-resistant Escherichia coli isolates, the American College of Obstetricians and Gynecologists (ACOG) recommended the use of narrow-spectrum antibiotics such as first-generation cephalosporins for prophylaxis in Caesarean deliveries [4]. However, in some newer studies it has been observed that throughout the years, with the use of wider-spectrum antibiotics, postpartum infectious morbidities have decreased [5]. With these findings and the rising resistance to commonly used antimicrobials, there is a need for new and wider-spectrum antibiotics for use in obstetrics. Moxifloxacin and levofloxacin are quinolones with a wide spectrum of antibiotic activity including Gram-positive and Gram-negative bacteria [6]. Cefoperazone, a third-generation cephalosporin, and cefepime, which is accepted as a fourth- generation cephalosporin, also have increased activity against Gram-negative and Gram-positive bacteria [7]. Regarding terato- genicity, both levofloxacin and moxifloxacin have been classified as category C and the cephalosporins as category B by the American Food and Drug Administration Pregnancy Category [8]. 0924-8579/$ – see front matter © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved. doi:10.1016/j.ijantimicag.2010.03.011