title: Moxifloxacin monotherapy versus ß-lactam mono- or combination therapy in hospitalized patients with community-acquired pneumonia.
abstract: OBJECTIVE
  In this observational study, we compared the outcomes of moxifloxacin monotherapy as compared to ß-lactam monotherapy as well as ß-lactam combination therapy in patients with community-acquired pneumonia (CAP).
  
  
  METHODS
  Patients recruited within the German Competence Network for CAP (CAPNETZ) were evaluated for treatment regimen. Primary outcome variables were six months overall mortality, pneumonia-related mortality according to clinical judgment and treatment failures (necessity for treatment change and death).
  
  
  RESULTS
  Overall, 4091 patients (mean age 64.4±17.8 (range 18-101) years, 2433 male (59.5%)) were included. 2068 patients received moxifloxacin (n=365) or ß-lactam monotherapy (n=1703). 330 patients died within six months. After controlling for confounders in multivariate analysis, moxifloxacin monotherapy had higher survival as compared to ß-lactam monotherapy (hazard ratio for moxifloxacin 0.57, 95% CI 0.35-0.92). Multivariate analysis including interaction terms showed that the protective effect of moxifloxacin was not present for CRB-65 class 0 but increased with higher CRB-65 scores (HR 0.69, 95% CI 0.50-0.96). Regarding pneumonia-related death, moxifloxacin monotherapy was also protective in multivariate analysis (HR 0.36, 95% CI 0.13-0.99). Moxifloxacin was also significantly associated with less treatment failures (p<0.001). In addition, it was not inferior to combination ß-lactam treatment (p=0.062).
  
  
  CONCLUSIONS
  In CRB-65 class 0 moxifloxacin was equivalent to ß-lactams. Our observations are in support of a use of moxifloxacin monotherapy in hospitalized patients with moderate CAP (CRB-65 classes 1 and 2).
authors.affiliation: Thoraxzentrum Ruhrgebiet, Department of Pneumology and Infectious Diseases, Herne und Bochum, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Ewig
authors.forename: H
authors.initials: H
authors.lastname: Hecker
authors.forename: N
authors.initials: N
authors.lastname: Suttorp
authors.forename: R
authors.initials: R
authors.lastname: Marre
authors.forename: T
authors.initials: T
authors.lastname: Welte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001372:Aza Compounds / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D024841:Fluoroquinolones; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D011804:Quinolines / Q000008:administration & dosage*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult; D047090:beta-Lactams / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D011804:Quinolines; D047090:beta-Lactams; D000077266:Moxifloxacin