To evaluate the efficacy and safety of sequential IV/PO and PO moxifloxacin (MXF) versus that of comparator (COMP) antibiotics in very elderly (≥75 years old) patients with CAP.
Data were pooled from all global, randomized, controlled trials of IV/PO (5 trials) and PO (5 trials) of MXF in the treatment of CAP. The pooled data were used to determine the clinical success rates and adverse event rates in the very elderly for both MXF and COMP-treated patients. The comparators were clarithromycin and amoxicillin in the PO studies and trovafloxacin, levofloxacin, ceftriaxone ± azithromycin and amoxicillin/clavulanate ± clarithromycin in the sequential IV/PO studies.
Of the 908 very elderly patients identified in the pooled analysis, 215 (114 MXF, 101 COMP) received PO and 693 (349 MXF, 344 COMP) received sequential IV/PO therapy. Of these, 158 PO-treated (84 MXF, 74 COMP) and 497 IV/PO-treated (248 MXF, 249 COMP) patients were valid for the primary efficacy analysis. Clinical success rates in IV/PO studies were 90% (222/248) for MXF vs. 83% (206/249) for COMP (95% CI 0.3%, 12%). For PO studies clinical success rates were 95% (80/84) for MXF vs. 86% (64/74) for COMP (95% CI 0.7%, 18.6%). Adverse and serious adverse event rates were similar in MXF- and COMP-treated patients.
Both IV and PO moxifloxacin were highly efficacious and safe in treating community acquired pneumonia in the very elderly and overall cure rates were significantly better in moxifloxacin treated-patients than those achieved with the comparator regimens.
Moxifloxacin appears to have excellent efficacy when used as empiric monotherapy for the treatment of CAP in very elderly patients.
Antonio Anzueto, Employee Dan Haverstock, Frank Kruesmann, Shurjeel Choudhri; Consultant fee, speaker bureau, advisory committee, etc.