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1918 Afr. J. Pharm. Pharmacol. (86.52%, 1001/1157), while statistically significant difference was found [RR = 1.04, 95% (0.99, 1.09), P=0.08] (Figure 4). Comparisons of safety All of the twenty-two RCTs provided adverse drug reaction data. In the total evaluable population, the incidence of adverse drug reaction between moxifloxacin group [509 (23.8%) of the 2136 patients] and control group [580 (27.9%) of the 2077 patients] had no statistically significant difference [RR = 0.88, 95%CI (0.72, 1.06), P = 0.17] (Figure 5). Comparisons of PID patients Judin (Judin et al., 2010), Heystek (Heystek et al., 2009) and Ross (Ross et al., 2006) altogether researched 1643 pelvic inflammatory disease (PID) patients. As the their studies recommended moxifloxacin as first-line therapy for pelvic inflammatory disease, we exclusively performed a meta-analysis for them. For the primary measure of efficacy [clinical cure rate at test-of-cure (TOC)], moxifloxacin was non-inferior to comparator (moxifloxacin: 624/701, 89.0%; comparator: 615/681, 90.3%) with no statistically significant difference between moxifloxacin and control group [RR = 0.98, 95%CI (0.95, 1.02), P = 0.33] (Figure 6). Microbiological success rates were 90.2% (119/132) for moxifloxacin and 85.1% (103/121) for comparator, whilst no statistically significant difference was found [RR = 1.06, 95%CI (0.96, 1.16), P = 0.25] (Figure 7). No statistically significant difference was found [RR = 0.85, 95%CI (0.68, 1.05), P = 0.13] (Figure 8) between moxifloxacin [38.5% (315/949)] versus the comparator [45.9% (406/884)] about adverse drug reaction rates. DISCUSSION We conducted this meta-analysis to compare the efficacy and safety of moxifloxacin monotherapy with conventional antimicrobial therapy for urogenital system infections. The overall RR of clinical rate, clinical effective rate and pathogens eradication rate of moxifloxacin were higher than control group. The results of meta-analysis indicated that efficacy of moxifloxacin was superior to conventional antibiotics therapy with statistically significant difference [Clinical cure rate: RR = 1.08, 95%CI (1.02, 1.14), P = 0.008; clinical effective rate: RR = 1.09, 95%CI (1.04, 1.14), P = 0.0005; pathogens eradication rate: RR = 1.04, 95% (0.99, 1.09), P = 0.08]. The safety profile analysis regarding the incidence of adverse drug reactions had no significant difference between moxifloxacin and control group [RR = 0.88, 95%CI (0.72, 1.06), P = 0.17]. Moreover, the efficacy and safety profile for PID patients (Judin, 2010; Heystek, 2009; Ross, 2006) were separately analyzed. These three large randomized controlled trials supported the efficacy of moxifloxacin for the treatment of uncomplicated PID. Clinical cure rates observed in the MONALISA (Judin et al., 2010) study were 78.4% for moxifloxacin versus 81.6% for levofloxacin plus metronidazole. Heysteck (2009) reported a clinical cure rate of 81.5% in women treated with moxifloxacin versus 83.2% in those treated with the doxycycline plus metronidazole plus one dose of ciprofloxacin. In the MAIDEN (Ross et al., 2006) study, clinical cure rate was achieved in 90.2% for moxifloxacin versus 90.7% for ofloxacin plus metronidazole. Metaanalysis indicated that the difference of efficacy between moxifloxacin monotherapy group and combination therapy group was not statistically significant (Clinical cure rates: RR = 0.98, 95%CI (0.95, 1.02), P = 0.33). In addition, no statistically significant differences were found in pathogens eradication rates (RR = 1.06, 95%CI (0.96, 1.16), P = 0.25) and the incidences of adverse drug reactions (RR = 0.85, 95%CI (0.68, 1.05), p = 0.13). Moxifloxacin monotherapy, 400 mg once daily for 14 days, is an effective and well-tolerated treatment for women with PID. Therefore, moxifloxacin can be recommended as the first-line therapy for uncomplicated PID. In all the included studies, moxifloxacin had the advantage of using single dose per day and did not need combination because of broad coverage to pathogens. Monotherapy is always associated with greater compliance than combination therapy (Haggerty and Ness, 2007), especially for outpatients. The administration of moxifloxacin was intravenous or oral and its medication time was free from diet (Instruction of Moxifloxacin Hydrochloride Tablets). Moxifloxacin can be accessible to inpatients and outpatients with greater compliance. The most common adverse events reported in the included studies were gastrointestinal disturbances and central nervous system reactions, such as nausea, diarrhea, vomiting, dizzy and headache. Serious adverse events were not reported in the enrolled articles. Balfour et al. (1999) demonstrated that in contrast to some other fluoroquinolones, moxifloxacin appears to have a low propensity for causing phototoxic and central nervous system (CNS) excitatory effects, and the most common adverse events are gastrointestinal disturbances. This meta-analysis is not without limitations. Certain limitations affecting the results of this meta-analysis should be taken into account. Firstly, our findings may be affected by the quality of trials included in the metaanalysis. Only five of the included trials were double blinding, and only three clarified adequate randomization procedures. A sensitivity analysis was performed including only trials that were double-blinded, the comparisons of pathogens eradication rates and incidence of adverse drug reaction were consistent with the primary results. The primary clinical effective rate of moxifloxacin was superiority to conventional antibiotics
Study or Subgroup Cai SF 2003 Gao HY 2005 Heystek2009 Jin X 2009 Judlin 2010 Li SQ 2008 Luo JL 2006(1) Luo JL 2006(2) Pei YH 2008 Ross2006 Sun GQ 2007 Tang JD 2009 Tian YP2005 Wang G2009 (a1) Wang G2009 (a2) Wang G2009 (b) Zhang GH 2007 Zhang WF 2004(1) Zhang WF 2004(2) Zhang YH 2009 Total (95% CI) Total events Heterogeneity: Tau² = 0.01; Chi² = 49.43, df = 19 (P = 0.0002); I² = 62% Test for overall effect: Z = 1.74 (P = 0.08) moxifloxacin conventional therapy Risk Ratio Risk Ratio Events 18 14 43 116 27 87 56 56 51 49 45 43 19 72 72 169 42 39 39 31 1088 Total 19 14 46 121 30 90 60 60 57 56 49 47 29 80 80 188 46 43 43 40 1198 Events 19 8 35 117 22 81 54 33 32 46 31 42 29 73 74 162 46 38 29 30 1001 Total 19 11 39 121 26 86 61 57 44 56 41 46 29 80 80 186 50 43 43 39 1157 Weight 5.1% 1.3% 5.6% 8.9% 3.4% 8.3% 6.3% 2.9% 3.5% 4.6% 3.7% 5.8% 2.3% 6.8% 7.0% 8.0% 5.9% 5.1% 2.9% 2.7% 100.0% M-H, Random, 95% CI 0.95 [0.82, 1.09] 1.36 [0.94, 1.99] 1.04 [0.91, 1.19] 0.99 [0.94, 1.04] 1.06 [0.87, 1.30] 1.03 [0.96, 1.10] 1.05 [0.94, 1.18] 1.61 [1.28, 2.03] 1.23 [1.01, 1.51] 1.07 [0.91, 1.25] 1.21 [1.00, 1.47] 1.00 [0.88, 1.14] 0.66 [0.51, 0.86] 0.99 [0.89, 1.09] 0.97 [0.88, 1.07] 1.03 [0.96, 1.11] 0.99 [0.88, 1.12] 1.03 [0.89, 1.19] 1.34 [1.07, 1.69] 1.01 [0.79, 1.28] 1.04 [0.99, 1.09] M-H, Random, 95% CI 0.5 0.7 1 1.5 2 Favours conventional Favours moxifloxacin Figure 4. Meta-analysis of pathogens eradication rates of moxifloxacin and conventional therapy. Study or Subgroup Cai SF 2003 Gao HY 2005 Heystek2009 Jin X 2009 Judlin 2010 Li SQ 2008 Luo JL 2006(1) Luo JL 2006(2) Luo XM 2006 Meng W 2009 Ross2006 Su XD 2010 Sun GQ 2007 Tang JD 2009 Tian YP2005 Wang G2009 (a1) Wang G2009 (a2) Wang G2009 (b) Wang X2009 Zhang GH 2007 Zhang WF 2004(1) Zhang WF 2004(2) Zhang YH 2009 Zheng HZ 2010 Total (95% CI) Total events Heterogeneity: Tau² = 0.07; Chi² = 46.31, df = 23 (P = 0.003); I² = 50% Test for overall effect: Z = 1.37 (P = 0.17) moxifloxacin conventional therapy Risk Ratio Risk Ratio Events 16 13 151 11 129 7 5 5 7 4 85 4 8 3 16 8 8 12 3 1 4 4 2 3 509 Total 22 20 343 121 228 90 52 52 56 25 378 60 44 50 29 80 80 150 60 38 43 43 40 32 2136 Events 6 9 162 11 132 8 7 5 41 8 112 6 6 3 18 5 9 13 0 2 5 7 3 2 580 Total 22 22 326 121 232 86 32 48 56 25 363 60 41 50 29 80 80 149 60 38 43 43 40 31 2077 Weight 4.6% 5.9% 12.9% 4.1% 13.0% 3.0% 2.6% 2.2% 4.8% 2.6% 11.6% 2.1% 3.0% 1.4% 8.2% 2.6% 3.4% 4.4% 0.4% 0.6% 2.0% 2.3% 1.1% 1.1% 100.0% M-H, Random, 95% CI 2.67 [1.29, 5.53] 1.59 [0.88, 2.88] 0.89 [0.75, 1.04] 1.00 [0.45, 2.22] 0.99 [0.85, 1.17] 0.84 [0.32, 2.21] 0.44 [0.15, 1.27] 0.92 [0.28, 2.99] 0.17 [0.08, 0.35] 0.50 [0.17, 1.45] 0.73 [0.57, 0.93] 0.67 [0.20, 2.24] 1.24 [0.47, 3.27] 1.00 [0.21, 4.72] 0.89 [0.58, 1.37] 1.60 [0.55, 4.68] 0.89 [0.36, 2.19] 0.92 [0.43, 1.94] 7.00 [0.37, 132.66] 0.50 [0.05, 5.28] 0.80 [0.23, 2.78] 0.57 [0.18, 1.81] 0.67 [0.12, 3.78] 1.45 [0.26, 8.11] 0.88 [0.72, 1.06] M-H, Random, 95% CI 0.1 0.2 0.5 1 2 5 10 Favours moxifloxacin Favours conventional Figure 5. Meta-analysis of the incidences of adverse drug reactions of moxifloxacin and conventional therapy. Mu et al. 1919
Page 1 and 2: African Journal of Pharmacy and Pha
Page 3 and 4: Editors Sharmilah Pamela Seetulsing
Page 5 and 6: Electronic submission of manuscript
Page 7 and 8: Fees and Charges: Authors are requi
Page 9 and 10: Table of Contents: Volume 6 Number
Page 13 and 14: Minimum inhibitory concentration (M
Page 15 and 16: Kim et al. 1887 Table 4. Antimicrob
Page 17 and 18: Klevens RM, Morrison M A, Nadle J,
Page 19 and 20: Figure 1. Chemical structure of ten
Page 21 and 22: ng/ml by 4.9 ml blank plasma with 5
Page 23 and 24: Figure 5. Chromatogram of plasma sp
Page 25 and 26: Figure 7. Chromatogram of a healthy
Page 27 and 28: Figure 11. Chromatograms of standar
Page 31 and 32: Shatoor 1903 Figure 1. The effect o
Page 33 and 34: Heart rate (Beats/min.) 345 330 315
Page 35 and 36: Table 2. Percent of changes in hear
Page 37 and 38: heart rate on coronary flow and car
Page 39 and 40: Urinary tract infections are the mo
Page 41 and 42: Table 1. Study characteristics of i
Page 43 and 44: Table 1. contd. Sun GQ 37 007 Ross
Page 45: Study or Subgroup Cai SF 2003 Gao H
Page 49 and 50: cure rate and clinical effective ra
Page 53 and 54: Table 1. The expression of KAI1 and
Page 57 and 58: Figure 2. Typical chromatograms of
Page 59 and 60: Excretion studies Figure 4 shows th
Page 63 and 64: Table 1. Statistical results of the
Page 65 and 66: ethinylestradiol /100 g levonorgest
Page 67 and 68: HO CH 2OH O OH OH OCH 2CH 2 OH Figu
Page 69 and 70: A B Figure 3. Bax positive cells of
Page 73 and 74: Table 1. Summary of specific reacti
Page 75 and 76: Figure 3. Effects of the sap of Jat
Page 79 and 80: Figure 1. A schematic diagram showi
Page 81 and 82: Chen et al. 1953 Figure 4. Concentr
Page 83 and 84: Figure 6. Representative photomicro
Page 85 and 86: shock. The features of PHC can expl
Page 87 and 88: Administration of single or repeate
Page 89 and 90: Table 1. Effects of green tea on SO
Page 91 and 92: Ozardali I, Bitiren M, Ali ZK, Zeri
Page 93 and 94: EXPERIMENTAL PROCEDURE Materials an
Page 95 and 96: Scavenging rate (%) Figure 1 Scaven
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A D Figure 5 Figure Effects 5. of E
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African Journal of Pharmacy and Pha
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Figure 1. Level-spacing distributio
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Number of cases Pattern Shi et al.
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sodium was then dissolved in 1000 m
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Concentration (ppm) Concentration (
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various contagious diseases such as
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Table 3. Antibacterial MIC (µg/ml)
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Table 5. Contd. 1/5 14.7 ± 0.6 39.
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UPCOMING CONFERENCES 6th European C
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