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

Safety Profile of Fluoroquinolones in CAP

Fluoroquinolones are generally safe and well tolerated.[65] The adverse events are predictable and mostly mild-to-moderate in severity. The most commonly reported adverse events with this drug class are gastrointestinal disturbances such as diarrhea and nausea, headaches and allergic reactions.[65] The most common treatment-related adverse events with gemifloxacin in a trial involving 345 patients, 169 of whom received at least one dose of gemifloxacin, were diarrhea, liver-function adverse events and rash.[56] A retrospective analysis of 177 elderly patients (≥65 years of age) receiving a 5- or 10-day regimen of levofloxacin found that the most common treatment-emergent adverse events in both groups were insomnia, constipation and headache.[66] In a trial comparing levofloxacin with cefotaxime plus ofloxacin, there were no significant differences for drug-related adverse events between the two groups.[67]

Antimicrobial-associated cardiac safety in elderly CAP patients is a concern. Increased risk of prolongation of the QTc interval and ventricular tachyarrhythmias are associated with macrolides and fluoroquinolones.[65] In the CAPRIE study, Morganroth et al. reported the safety profiles of moxifloxacin and levofloxacin in the treatment of CAP in hospitalized patients aged 65 years or more.[22,68] This study showed that 16 moxifloxacin-treated patients (8.3%) and ten levofloxacin-treated patients (5.1%) experienced a primary composite cardiac event in a population of 387 patients. Most events were nonsustained ventricular tachycardia. No deaths clearly related to the study drugs occurred during the observation period, and no statistically significant differences in drug-related adverse events were observed between the two treatment groups.[22,68]

The Moxifloxacin Treatment IV (MOTIV) study found monotherapy with intravenous/oral moxifloxacin to be as efficacious and safe as combination therapy with ceftriaxone plus levofloxacin for the treatment of CAP in hospitalized patients. There were no statistically significant differences in the incidence of treatment-emergent adverse events or in mortality between the two treatments.[69]

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