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.
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.
Welte
Tobias
T
Department of Pulmonary Medicine, Medizinische Hochschule Hannover, Hannover, Germany. welte.tobias@mh-hannover.de
Petermann
Wolfgang
W
Schürmann
Dirk
D
Bauer
Torsten Thomas
TT
Reimnitz
Peter
P
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
D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D004917:Erythromycin; D002443:Ceftriaxone; D000077266:Moxifloxacin