Fluoroquinolones in the Management of Community-acquired Pneumonia in Primary Care

Brian Wispelwey; Katherine R Schafer

Disclosures

Expert Rev Anti Infect Ther. 2010;8(11):1259-1271. 

In This Article

Clinical Benefits seen with Fluoroquinolone Therapy

The fluoroquinolones have demonstrated efficacy against typical CAP pathogens in a large number of clinical trials conducted during the last decade. Early trials of levofloxacin in adults with CAP caused by S. pneumoniae showed that the antibiotic could achieve high rates (96.3%) of clinical success in patients with macrolide-resistant infections.[55]

The oral bioavailability of the fluoroquinolones has resulted in effective oral alternatives to traditional intravenous antibiotics for the treatment of hospitalized patients with CAP. Oral gemifloxacin was compared with sequential therapy with intravenous ceftriaxone/oral cefuroxime in 345 patients hospitalized for CAP. Bacteriological success rates were 90.6% for gemifloxacin and 87.3% for ceftriaxone/cefuroxime. The clinical success rate in bacteremic patients was 100% at follow-up in both groups.[56]

In the Moxirapid study, treatment with sequential intravenous or oral moxifloxacin was associated with faster clinical improvement, defervescence and relief of symptoms such as chest pain, than standard therapy with high-dose ceftriaxone with or without erythromycin for hospitalized patients with CAP who received initial parenteral therapy.[57] Time to resolution of fever occurred sooner (3 vs 4 days) and duration of hospital admission was significantly shorter (1.3 days less) for those receiving moxifloxacin compared with those treated with a standard combination regimen.[57] These results were confirmed by another study which compared sequential intravenous and oral moxifloxacin with sequential intravenous and oral co-amoxiclav with or without clarithromycin in patients with CAP requiring initial parenteral treatment. Not only was resolution of fever faster (2 vs 3 days) and duration of hospitalization shorter (~1 day), but a larger proportion of patients in the moxifloxacin group than patients in the comparator group converted to oral therapy immediately after the initial mandatory 3-day intravenous treatment (50.2 vs 17.8%, respectively).[58] In the Community-Acquired Pneumonia Recovery in the Elderly (CAPRIE) study, intravenous/oral moxifloxacin therapy was associated with faster clinical recovery than intravenous/oral levofloxacin therapy in the treatment of CAP in hospitalized patients aged 65 years or more.[22] Clinical recovery by days 3–5 after the start of treatment was 97.9% in the moxifloxacin arm versus 90.0% in the levofloxacin arm (95% CI: 1.7–14.1; p = 0.01).[22]

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