Hemorrhage, Diarrhea, and Superinfection Associated with the Use of Moxalactam

Serious adverse effects resulting from the use of moxalactam, although reported as infrequent, include hypoprothrombinemia, hemorrhage, diarrhea (including pseudomembranous colitis), superinfection, seizures, and reactions similar to those seen with the use of disulfiram. The authors administered 2-8 g of moxalactam daily to six elderly and debilitated patients with serious infections for periods ranging from one to 18 days. The goal was to use a single "safe" drug to avoid the potential nephrotoxicity encountered with aminoglycosides. Although the antibacterial spectrum of moxalactam makes it suitable for single-drug therapy in many serious infections, the frequent occurrence of pronounced toxicity in elderly patients is a major disadvantage. The frequency of hemorrhage associated with moxalactam therapy suggests that this drug has a more profound effect on intestinal flora than other beta -lactam antibiotics, perhaps because of its greater biliary concentrations. Alternatively, the unique molecular structure of moxalactam may in some way impair the hepatic synthesis of prothrombin. The presence of renal failure in two of the three patients in our study who hemorrhaged suggests that this may be an additional risk factor.