What is the role of moxifloxacin in intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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In 2003, a trial reported by Drummond et al compared sequential intravenous/oral monotherapy with moxifloxacin (400 mg/d) to intravenous/oral co-amoxiclav (1.2 g IV/625 mg PO tid) with or without clarithromycin (500 mg bid) for 7-14 days in hospitalized patients with CAP and found that intravenous/oral monotherapy with moxifloxacin shows clinical benefits, including increased speed of response, and is cost-effective compared with intravenous/oral co-amoxiclav with or without clarithromycin. [30]

Similarly, in 2002, Finch et al noted that monotherapy with moxifloxacin is superior to a standard combination regimen of a beta-lactam and a beta-lactamase inhibitor (co-amoxiclav) with or without a macrolide (clarithromycin) in the treatment of patients with CAP admitted to a hospital. [31]

Specifically, Finch et al noted the superiority of moxifloxacin irrespective of the pneumonia severity and regardless of whether the combination therapy included a macrolide. The time to resolution of fever was also statistically significantly faster in patients who received moxifloxacin (median time, 2 vs 3 d), and the duration of hospital admission was approximately 1 day less among patients who received moxifloxacin. The treatment was converted to oral therapy immediately after the initial mandatory 3-day period of intravenous administration for a larger proportion of patients in the moxifloxacin group than patients in the comparator group (151 [50.2%] vs 57 [17.8%] patients). Fewer deaths (9 [3%] vs 17 [5.3%]) and fewer serious adverse events (38 [12.6%] vs 53 [16.5%]) were reported in the moxifloxacin group than in the comparator group. [31]

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