Although it has been suggested that patients with pre-existing risk factors or co-morbidities may be at particular risk of experiencing an AE, our data did not reveal any clinically relevant differences compared with the comparators in this context. This holds true not only for comparisons with other fluoroquinolones, but also for comparisons with other antibiotic classes. All but one of the studies used in the present analysis had the evaluation of the clinical efficacy of moxifloxacin in the target indications as a primary goal, and the majority of the studies have been published in peer-reviewed journals (see references[26,27,29] for recent

review papers). Most studies concluded that moxifloxacin was clinically as effective as the comparators or superior to them, which implies that moxifloxacin was not ACY-738 cost underdosed (all patients received the standard registered dose that has proven to be efficacious in all registered indications to date).

This contrasts with some of the comparators (including those proposed as first-line therapies in applicable guidelines), for which higher dosages than those used in the studies pooled for the current analysis are now proposed. For β-lactams[67–69] and levofloxacin,[70] this reflects the progressive decrease in bacterial susceptibility over time and the corresponding attempts by clinicians to maintain sufficient treatment efficacy based on pharmacokinetic/dynamic principles and to avoid failures[71] and/or emergence of resistance.[72,73] As with all meta-analyses, the present study and its conclusions have several limitations. https://www.selleckchem.com/products/verubecestat.html Although we looked at specific risks, Epigenetics inhibitor we did not reanalyze the original investigators’ statements or medical assessment of the corresponding cases, nor made any attempt at further adjudication of specific events. No exploration of heterogeneity of results across

studies was done, because of the large number of comparisons. Lastly, although a large number of patients were included in the analysis, it may not be sufficient for detecting very rare side effects. These are usually captured from post-marketing spontaneous reports and larger non-interventional studies, but such reports are subject to other limitations relating to the quality of reporting, difficulties in ensuring unbiased data collection, and lack of detailed information on the patient characteristics. Moreover, while the population at risk is known for non-interventional studies, the actual number of exposed persons is difficult to determine for spontaneous reports. Thus, other approaches need to be followed to further define the safety profile of drugs when they are administered in a real-life setting. This has already been carried out for hepatotoxicity using a registry approach to compare telithromycin and several fluoroquinolones, including moxifloxacin[74] (that study did not reveal significant differences between moxifloxacin and the other fluoroquinolones marketed at that time in this context).