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: S Ewig, H Hecker, N Suttorp, R Marre, T Welte, CAPNETZ study group
• Journal: The Journal of infection (J Infect) Vol. 62 Issue 3 Pg. 218-25 (Mar 2011) ISSN: 1532-2742 [Electronic] England
• PMID: 21276814 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Aza Compounds
• Fluoroquinolones
• Quinolines
• beta-Lactams
• Moxifloxacin

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (administration & dosage)
• Aza Compounds (administration & dosage)
• Community-Acquired Infections (drug therapy, mortality)
• Drug Therapy, Combination (methods)
• Female
• Fluoroquinolones
• Humans
• Male
• Middle Aged
• Moxifloxacin
• Pneumonia, Bacterial (drug therapy, mortality)
• Quinolines (administration & dosage)
• Survival Analysis
• Treatment Outcome
• Young Adult
• beta-Lactams (administration & dosage)