Moxifloxacin monotherapy versus beta-lactam mono- or combination therapy in hospitalized patients with community-acquired pneumonia

作者：Ewig S; Hecker H; Suttorp N; Marre R; Welte T^*

来源：Journal of Infection, 2011, 62(3): 218-225.

DOI：10.1016/j.jinf.2011.01.009

• Community-acquired pneumonia
• Therapy
• Fluoroquinolones
• beta-Lactams

Objective: In this observational study, we compared the outcomes of moxifloxacin monotherapy as compared to beta-lactam monotherapy as well as beta-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 beta-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 beta-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 beta-lactam treatment (p = 0.062).
Conclusions: In CRB-65 class 0 moxifloxacin was equivalent to beta-lactams. Our observations are in support of a use of moxifloxacin monotherapy in hospitalized patients with moderate CAP (CRB-65 classes 1 and 2).

• 出版日期2011-3