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Randomized controlled trial of sequential intravenous (i.v.) and oral moxifloxacin compared with sequential i.v. and oral co-amoxiclav with or without clarithromycin in patients with community-acquired pneumonia requiring initial parenteral treatment.
Antimicrob Agents Chemother. 2002 Jun; 46(6):1746-54.AA

Abstract

The objective of the present trial was to compare the efficacy, safety, and tolerability of moxifloxacin (400 mg) given intravenously (i.v.) once daily followed by oral moxifloxacin (400 mg) for 7 to 14 days with the efficacy, safety, and tolerability of co-amoxiclav (1.2 g) administered by i.v. infusion three times a day followed by oral co-amoxiclav (625 mg) three times a day, with or without clarithromycin (500 mg) twice daily (i.v. or orally), for 7 to 14 days in adult patients with community-acquired pneumonia requiring initial parenteral therapy. A total of 628 patients were enrolled and assessed by evaluation of their clinical and bacteriological responses 5 to 7 days and 21 to 28 days after administration of the last dose of study medication. Although the trial was designed, on the basis of predefined outcomes, to demonstrate the equivalence of the two regimens, the results showed statistically significant higher clinical success rates (for moxifloxacin, 93.4%, and for comparator regimen, 85.4%; difference [Delta], 8.05%; 95% confidence interval [CI], 2.91 to 13.19%; P = 0.004) and bacteriological success rates (for moxifloxacin, 93.7%, and for comparator regimen, 81.7%; Delta, 12.06%; 95% CI, 1.21 to 22.91%) for patients treated with moxifloxacin. This superiority was seen irrespective of the severity of the pneumonia and whether or not the combination therapy included a macrolide. The time to resolution of fever was also statistically significantly faster for patients who received moxifloxacin (median time, 2 versus 3 days), and the duration of hospital admission was approximately 1 day less for patients who received moxifloxacin. The treatment was converted to oral therapy immediately after the initial mandatory 3-day period of i.v. administration for a larger proportion of patients in the moxifloxacin group than patients in the comparator group (151 [50.2%] versus 57 [17.8%] patients). There were fewer deaths (9 [3.0%] versus 17 [5.3%]) and fewer serious adverse events (38 [12.6%] versus 53 [16.5%]) in the moxifloxacin group than in the comparator group. The rates of drug-related adverse events were comparable in both groups (38.9% in each treatment group). The overall incidence of laboratory abnormalities was similar in both groups. Thus, it is concluded that monotherapy with moxifloxacin is superior to that with 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 community-acquired pneumonia admitted to a hospital.

Authors+Show Affiliations

Nottingham City Hospital, Nottingham. Bayer plc, Newbury, United Kingdom. r.finch@nottingham.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

12019085

Citation

Finch, R, et al. "Randomized Controlled Trial of Sequential Intravenous (i.v.) and Oral Moxifloxacin Compared With Sequential I.v. and Oral Co-amoxiclav With or Without Clarithromycin in Patients With Community-acquired Pneumonia Requiring Initial Parenteral Treatment." Antimicrobial Agents and Chemotherapy, vol. 46, no. 6, 2002, pp. 1746-54.
Finch R, Schürmann D, Collins O, et al. Randomized controlled trial of sequential intravenous (i.v.) and oral moxifloxacin compared with sequential i.v. and oral co-amoxiclav with or without clarithromycin in patients with community-acquired pneumonia requiring initial parenteral treatment. Antimicrob Agents Chemother. 2002;46(6):1746-54.
Finch, R., Schürmann, D., Collins, O., Kubin, R., McGivern, J., Bobbaers, H., Izquierdo, J. L., Nikolaides, P., Ogundare, F., Raz, R., Zuck, P., & Hoeffken, G. (2002). Randomized controlled trial of sequential intravenous (i.v.) and oral moxifloxacin compared with sequential i.v. and oral co-amoxiclav with or without clarithromycin in patients with community-acquired pneumonia requiring initial parenteral treatment. Antimicrobial Agents and Chemotherapy, 46(6), 1746-54.
Finch R, et al. Randomized Controlled Trial of Sequential Intravenous (i.v.) and Oral Moxifloxacin Compared With Sequential I.v. and Oral Co-amoxiclav With or Without Clarithromycin in Patients With Community-acquired Pneumonia Requiring Initial Parenteral Treatment. Antimicrob Agents Chemother. 2002;46(6):1746-54. PubMed PMID: 12019085.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized controlled trial of sequential intravenous (i.v.) and oral moxifloxacin compared with sequential i.v. and oral co-amoxiclav with or without clarithromycin in patients with community-acquired pneumonia requiring initial parenteral treatment. AU - Finch,R, AU - Schürmann,D, AU - Collins,O, AU - Kubin,R, AU - McGivern,J, AU - Bobbaers,H, AU - Izquierdo,J L, AU - Nikolaides,P, AU - Ogundare,F, AU - Raz,R, AU - Zuck,P, AU - Hoeffken,G, PY - 2002/5/23/pubmed PY - 2002/10/31/medline PY - 2002/5/23/entrez SP - 1746 EP - 54 JF - Antimicrobial agents and chemotherapy JO - Antimicrob. Agents Chemother. VL - 46 IS - 6 N2 - The objective of the present trial was to compare the efficacy, safety, and tolerability of moxifloxacin (400 mg) given intravenously (i.v.) once daily followed by oral moxifloxacin (400 mg) for 7 to 14 days with the efficacy, safety, and tolerability of co-amoxiclav (1.2 g) administered by i.v. infusion three times a day followed by oral co-amoxiclav (625 mg) three times a day, with or without clarithromycin (500 mg) twice daily (i.v. or orally), for 7 to 14 days in adult patients with community-acquired pneumonia requiring initial parenteral therapy. A total of 628 patients were enrolled and assessed by evaluation of their clinical and bacteriological responses 5 to 7 days and 21 to 28 days after administration of the last dose of study medication. Although the trial was designed, on the basis of predefined outcomes, to demonstrate the equivalence of the two regimens, the results showed statistically significant higher clinical success rates (for moxifloxacin, 93.4%, and for comparator regimen, 85.4%; difference [Delta], 8.05%; 95% confidence interval [CI], 2.91 to 13.19%; P = 0.004) and bacteriological success rates (for moxifloxacin, 93.7%, and for comparator regimen, 81.7%; Delta, 12.06%; 95% CI, 1.21 to 22.91%) for patients treated with moxifloxacin. This superiority was seen irrespective of the severity of the pneumonia and whether or not the combination therapy included a macrolide. The time to resolution of fever was also statistically significantly faster for patients who received moxifloxacin (median time, 2 versus 3 days), and the duration of hospital admission was approximately 1 day less for patients who received moxifloxacin. The treatment was converted to oral therapy immediately after the initial mandatory 3-day period of i.v. administration for a larger proportion of patients in the moxifloxacin group than patients in the comparator group (151 [50.2%] versus 57 [17.8%] patients). There were fewer deaths (9 [3.0%] versus 17 [5.3%]) and fewer serious adverse events (38 [12.6%] versus 53 [16.5%]) in the moxifloxacin group than in the comparator group. The rates of drug-related adverse events were comparable in both groups (38.9% in each treatment group). The overall incidence of laboratory abnormalities was similar in both groups. Thus, it is concluded that monotherapy with moxifloxacin is superior to that with 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 community-acquired pneumonia admitted to a hospital. SN - 0066-4804 UR - https://www.unboundmedicine.com/medline/citation/12019085/Randomized_controlled_trial_of_sequential_intravenous__i_v___and_oral_moxifloxacin_compared_with_sequential_i_v__and_oral_co_amoxiclav_with_or_without_clarithromycin_in_patients_with_community_acquired_pneumonia_requiring_initial_parenteral_treatment_ L2 - http://aac.asm.org/cgi/pmidlookup?view=long&pmid=12019085 DB - PRIME DP - Unbound Medicine ER -