title: Treatment with sequential intravenous or oral moxifloxacin was associated with faster clinical improvement than was standard therapy for hospitalized patients with community-acquired pneumonia who received initial parenteral therapy.
abstract: BACKGROUND
  Although third-generation cephalosporins, such as ceftriaxone (CTRX), and pneumococcal fluoroquinolones, such as moxifloxacin (MXF), are currently recommended first-line antibiotics for empirical treatment of inpatients with community-acquired pneumonia, CTRX and MXF have never undergone a head-to-head comparison. We therefore compared the efficacy, safety, and speed and quality of defervescence of sequential intravenous or oral MXF and high-dose CTRX with or without erythromycin (CTRX+/-ERY) for patients with community-acquired pneumonia requiring parenteral therapy.
  
  
  METHODS
  In this prospective, multicenter, randomized, controlled, nonblinded study, 397 patients were randomly assigned to receive either MXF (400 mg once daily intravenously, possibly followed by oral tablets) or CTRX (2 g intravenously once daily) with or without ERY (1 g intravenously every 6-8 h) for 7-14 days.
  
  
  RESULTS
  Among 317 patients evaluable for efficacy and safety, 138 (85.7%) of 161 MXF-treated patients and 135 (86.5%) of 156 CTRX+/-ERY-treated patients (59 [37.8%] of whom received CTRX and ERY) achieved continued clinical resolution. Defervescence and relief of symptoms, such as chest pain, occurred significantly earlier in the MXF-treated group than in the CTRX+/-ERY-treated group. Both regimens were generally well tolerated.
  
  
  CONCLUSIONS
  For adult patients hospitalized with community-acquired pneumonia, sequential MXF therapy was clinically equivalent to high-dose CTRX+/-ERY therapy but led to a faster clinical improvement.
authors.affiliation: Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Hannover, Germany. welte.tobias@mh-hannover.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Petermann
authors.forename: Dirk
authors.initials: D
authors.lastname: Schürmann
authors.forename: Torsten Thomas
authors.initials: TT
authors.lastname: Bauer
authors.forename: Peter
authors.initials: P
authors.lastname: Reimnitz
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001372:Aza Compounds / Q000008:administration & dosage*; D002443:Ceftriaxone / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy; D004359:Drug Therapy, Combination; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D024841:Fluoroquinolones; D006760:Hospitalization; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D000077266:Moxifloxacin; D010288:Parenteral Nutrition; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D011446:Prospective Studies; D011804:Quinolines / Q000008:administration & dosage*; D012074:Remission Induction; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D004917:Erythromycin; D002443:Ceftriaxone; D000077266:Moxifloxacin