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Clinical Investigations: INFECTIONS |

Oral Moxifloxacin vs High-Dosage Amoxicillin in the Treatment of Mild-to-Moderate, Community-Acquired, Suspected Pneumococcal Pneumonia in Adults*

Patrick Petitpretz, MD; Pierre Arvis, MD; Miroslav Marel, MD, FCCP; Joaquim Moita, MD; Juan Urueta, MD; the CAP5 Moxifloxacin Study Group
Author and Funding Information

Affiliations: *From the Service de Pneumologie (Dr. Petitpretz), Hôpital André Mignot, Le Chesnay, France; Bayer (Dr. Arvis), Puteaux Paris Cedex, France; Servicio de Pneumologia (Dr. Moita), Centro Hospitalar de Coimbra, Coimbra, Portugal; Department of Pneumonology (Dr. Marel), Faculty Hospital Motol, Charles University, Prague, Czech Republic; Instituto Nacional de Enfermedades Respiratorias (Dr. Urueta), Servicio de Urgencias, Calz de Tialpan, Col. Torriello Guerra, Mexico. ,  A complete list of members of the CAP5 Moxifloxacin Study Group is listed in the Appendix. This was a multicenter study initiated and supported by Bayer AG.

Correspondence to: Patrick Petitpretz, MD, Service de Pneumologie, Hôpital André Mignot, 177 route de Versailles, 78157 Le Chesnay, France; e-mail: ppetitpretz@ch-versailles.fr



Chest. 2001;119(1):185-195. doi:10.1378/chest.119.1.185
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Study objectives: Comparison of the efficacy and safety of moxifloxacin vs amoxicillin for treatment of mild-to-moderate, suspected pneumococcal community-acquired pneumonia (CAP) in adult patients.

Design: Multinational, multicenter, double-blind, randomized study.

Setting: Eighty-two centers in 20 countries (Argentina, Brazil, Chile, Croatia, Czech Republic, Estonia, France, Hong Kong, Hungary, Lithuania, Mexico, Portugal, Russia, Slovenia, South Africa, Spain, Turkey, Ukraine, United Kingdom, and Uruguay).

Patients: Four hundred eleven adults (inpatients or outpatients) with suspected pneumococcal CAP.

Interventions: Randomization 1:1 to moxifloxacin, 400 mg/d, or amoxicillin, 1,000 g tid, for 10 days.

Results: Primary efficacy parameter was clinical response, 3 to 5 days after therapy (end of therapy [EOT]) in the per protocol (PP) population (362 patients). The clinical success rate in the PP population was 91.5% (moxifloxacin) and 89.7% (amoxicillin; two-sided 95% confidence interval, −4.2 to 7.8%). The clinical cure rate in patients with proven pneumococcal pneumonia was similar in both treatment groups (87.8%). The bacteriologic success rate in 136 bacteriologically evaluable patients at the EOT was 89.7% (moxifloxacin) and 82.4% (amoxicillin). The bacteriologic success rate against Streptococcus pneumoniae was 89.6% (moxifloxacin) and 84.8% (amoxicillin). The frequency of adverse events was comparable in both treatment groups. Digestive symptoms were the most common drug-related adverse events in both treatment groups.

Conclusions: Moxifloxacin was statistically at least as effective as high-dose amoxicillin for treatment of mild-to-moderate, suspected pneumococcal CAP. Moxifloxacin may be an alternative for empiric CAP treatment, especially in areas where multidrug resistance in S pneumoniae is sufficiently prevalent to preclude routine penicillin.Key words: amoxicillin; community-acquired pneumonia; moxifloxacin; oral therapy; Streptococcus pneumoniae


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