Prophylactic use of moxifloxacin in patients receiving bone marrow transplants was not associated with increased ciprofloxacin resistance in Escherichia coli and enterococci.

Figure 1. Correlation between annual rates of resistance to ciprofloxacin in enterococci and Escherichia coli isolates and consumption of 3 fluoroquinolones (ciprofloxacin, levofloxacin, and moxifloxacin) from 2001 through 2003 at National Taiwan University Hospital. Isolates were recovered from patients treated in a hematology/oncology ward (A) and a bone marrow transplantation ward (B). DDD, defined daily dose. (among antiretrovirals) possesses a rather large therapeutic index; (2) abacavir toxicity, particularly the hypersensitivity reaction, does not appear to be related to abacavir levels; and (3) if the administration of antiretrovirals to persons with hepatic impairment were limited to only those drugs for which adequate pharmacokinetic and safety data are available, many of the currently available antiretrovirals would be eliminated. If you combine these points with emerging data that suggest control of HIV infection may slow the progression of hepatitis C virus–related liver disease in coinfected individuals [4, 5], these limitations could certainly adversely impact the survival and quality of life of persons with HIV and hepatitis C virus infections. In our letter [3], we took a less dogmatic approach, stating that treatment with the drug should not be withheld if other compelling factors support the use of abacavir in the presence of more advanced hepatic dysfunction [3].