Safety and efficacy of sequential i.v. to p.o. moxifloxacin versus conventional combination therapies for the treatment of community-acquired pneumonia in patients requiring initial i.v. therapy

• Published in: The Journal of emergency medicine 2004-11, Vol.27 (4), p.395-405
• Main Authors: Katz, Eric, Larsen, L.Scott, Fogarty, Charles M., Hamed, Kamal, Song, James, Choudhri, Shurjeel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Aza Compounds - adverse effects; Aza Compounds - therapeutic use; azithromycin; Azithromycin - adverse effects; Azithromycin - therapeutic use; ceftriaxone; Ceftriaxone - adverse effects; Ceftriaxone - therapeutic use; cefuroxime; Community-Acquired Infections - drug therapy; Community-Acquired Infections - ethnology; community-acquired pneumonia; Constipation - chemically induced; Drug Therapy, Combination - adverse effects; Drug Therapy, Combination - therapeutic use; Emergency Medical Services; Female; Fluoroquinolones; Humans; Male; Metronidazole - adverse effects; Metronidazole - therapeutic use; Middle Aged; moxifloxacin; Nausea - chemically induced; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - microbiology; Prospective Studies; Quinolines - adverse effects; Quinolines - therapeutic use; Safety; Time Factors; Treatment Outcome
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2004.02.023

To compare the efficacy of sequential i.v. to p.o. moxifloxacin with ceftriaxone ± azithromycin ± metronidazole for the treatment of patients with community acquired pneumonia (CAP), a multi-centered, prospective, randomized, open label study was performed. CAP patients were randomized to moxifloxacin (400 mg/d—at least one i.v. dose) or ceftriaxone (at least one dose of 2 g i.v. q.d. followed by cefuroxime 500 mg p.o. b.i.d.) ± azithromycin, ± metronidazole (cephalosporin/macrolide control: CMC). The primary endpoint was clinical response at test-of-cure (TOC) visit. Bacteriological response at TOC was the secondary endpoint. Clinical cure was found in 83.3% (90/108) of moxifloxacin patients and 79.6% (90/113) of control patients. Microbiological responses were 81.8% (18/22) for moxifloxacin and 60.7% (17/28) for CMC patients. Drug-related adverse events occurred in 18.0% of moxifloxacin and 16% of CMC patients. It is concluded that i.v. to p.o. moxifloxacin is as effective as CMC for treatment of CAP and is a reliable alternative antimicrobial therapy.