Effectiveness of oral moxifloxacin in standard first-line therapy in community-acquired pneumonia

Torres, Antoni; Muir, J F; Corris, Paul; Kubin, R; Duprat-Lomon, I; Sagnier, Pierre-Philippe; Höffken, G.

doi:10.1183/09031936.03.00045202

Cited by 80 publications

(61 citation statements)

References 42 publications

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“…First, consider our motivating example: fluoroquinolones. For community-acquired pneumonia, use of newer fluoroquinolones has been suggested as a means of averting treatment failure (18,26). Our model suggests the risk that this benefit would come at the cost of promoting high-level fluoroquinolone resistance; however, the properties of these agents to date seem to minimize such risk.…”

Section: Discussionmentioning

confidence: 42%

Upgrading antibiotic use within a class: Tradeoff between resistance and treatment success

Wang¹,

Lipsitch

2006

Proc. Natl. Acad. Sci. U.S.A.

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Increasing resistance to antibiotics creates the need for prudent antibiotic use. When resistance to various antibiotics within a class is driven by stepwise accumulation of mutations, a dilemma may exist in regard to replacing an antibiotic that is losing effectiveness due to resistance with a new drug within the same class. Such replacement may enhance treatment success in the short term but promote the spread of highly resistant strains. We used mathematical models to quantify the tradeoff between minimizing treatment failures (by switching early) and minimizing the proliferation of the highly resistant strain (by delaying the switch). Numerical simulations were applied to investigate the cumulative prevalence of the highly resistant strain (Resistance) and the cumulative number of treatment failures (Failure) that resulted from following different antibiotic use policies. Whereas never switching to the new drug always minimizes Resistance and maximizes Failure, immediate switching usually maximizes Resistance and minimizes Failure. Thus, in most circumstances, there is a strict tradeoff in which early use of the new drug enhances treatment effectiveness while hastening the rise of high-level resistance. This tradeoff is most acute when acquired resistance is rare and the highly resistant strain is readily transmissible. However, exceptions occur when use of the new drug frequently leads to acquired resistance and when the highly resistant strain has substantial ''fitness cost''; these circumstances tend to favor an immediate switch. We discuss the implications of these considerations in regard to antibiotic choices for Streptococcus pneumoniae.antibiotic resistance ͉ fluoroquinolones ͉ mathematical models ͉ optimization

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Section: Discussionmentioning

confidence: 42%

Upgrading antibiotic use within a class: Tradeoff between resistance and treatment success

Wang¹,

Lipsitch

2006

Proc. Natl. Acad. Sci. U.S.A.

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“…Of the included trials, 8 trials included only patients with severe or moderate-to-severe pneumonia. 16,18,19,21,22,28,30,36 Six additional trials enrolled patients with severe pneumonia; 17,26,27,29,33,34 however, the majority of enrolled patients had mild to moderate pneumonia. The guidelines of the American Thoracic Society 37 and Pneumonia Severity Index score class IV and V 38 were mainly used for assessment of severe pneumonia.…”

Section: Included Trialsmentioning

confidence: 99%

“…Data about mortality in the intention-to-treat population were provided in 18 trials [14][15][16][17][18][19]21,22,24,26,27,[29][30][31][32][33][34]36 and ranged from 0% to 7% (mean 2.7%) in the fluoroquinolone groups and from 0.5% to 8% (mean 3.4%) in the comparator groups. Mortality rates were not different between the 2 groups of patients (Figure 2, OR 0.85, 95% CI 0.65-1.12).…”

Section: Mortalitymentioning

confidence: 99%

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Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Vardakas¹,

Siempos²,

Grammatikos³

et al. 2008

Canadian Medical Association Journal

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CMAJ ResearchBackground: We investigated whether the use of respiratory fluoroquinolones was associated with better clinical outcomes compared with the use of macrolides and β-lactams among adults with pneumonia. Methods:We searched PubMed, Current Contents, Scopus, EMBASE, ClinicalTrials.gov and Cochrane with no language restrictions. Two reviewers independently extracted data from published trials that compared fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin) with macrolides or β-lactams or both. A meta-analysis was performed with the clinical outcomes of mortality, treatment success and adverse outcomes. Results:We included 23 trials in our meta-analysis. There was no difference in mortality among patients who received fluoroquinolones or the comparator antibiotics (OR 0.85, 95% CI 0.65-1.12). Pneumonia resolved in more patients who received fluoroquinolones compared with the comparator antibiotics for the included outcomes in the intention-to-treat population (OR 1.17, 95% CI 1.00-1.36), clinically evaluable population (OR 1.26, 95% CI 1.06-1.50) and the microbiologically assessed population (OR 1.67, 95% CI 1.28-2.20). Fluoroquinolones were more effective than a combination of β-lactam and macrolide (OR 1.39, 95% CI 1.02-1.90). They were also more effective for patients with severe pneumonia (OR 1.84, 95% CI 1.02-3.29), those who required admission to hospital (OR = 1.30, 95% CI 1.04-1.61) and those who required intravenous therapy (OR = 1.44, 15% CI 1.13-1.85). Fluoroquinolones were more effective than β-lactam and macrolide in open-label trials (OR = 1.35, 95% CI 1.08-1.69) but not in blinded randomized controlled trials (OR = 1.13, 95% CI 0.85-1.50).Interpretation: Fluoroquinolones were associated with higher success of treatment for severe forms of pneumonia; however, a benefit in mortality was not evident. A randomized controlled trial that includes patients with severe pneumonia with or without bacteremia is needed.

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“…Przedstawiona skuteczność fluorochinolonu przy porówny-walnej liczbie działań ubocznych pozwoliła na rekomendowanie takiego postępowania jako standardowego w pierwszej linii leczenia [52].…”

Section: Zapalenia Płucunclassified

Lewofloksacyna i moksyfloksacyna w leczeniu zakażeń bakteryjnych

Płusa¹

2016

Forum Zakażeń

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STRESZCZENIE: Klasyfikacja fluorochinolonów została oparta na spektrum mikrobiologicznym i cechach farmakokinetycznych kolejno wprowadzanych preparatów, które charakteryzowały się lepszymi właściwościami farmakodynamicznymi, w tym znaczną penetracją do wnę-trza makrofagów i miejsca toczącego się procesu zapalnego. Przeprowadzona porównaw-cza analiza lewofloksacyny i moksyfloksacyny wskazuje na ich skuteczność kliniczną w kontrolowaniu zakażeń układowych zarówno w obrębie układu oddechowego, jak i moczowego, zwłaszcza w przypadku lewofloksacyny. Z tego powodu obydwa preparaty znalazły się w obowiązujących obecnie rekomendacjach postępowania w zakażeniach. Narastająca oporność na antybiotyki zmusza do ich racjonalnego stosowania -zgodnego ze światowymi wytycznymi.SŁOWA KLUCZOWE: lewofloksacyna, moksyfloksacyna, zakażenie ABSTRACT: Classification of fluoroquinolones is based on the spectrum of microbiological and pharmacokinetic characteristics in turn introduced preparations, which were characterized by improved pharmacodynamic properties, including significant penetration into the macrophages and inflammatory tissue. Conducted a comparative analysis of levofloxacin and moxifloxacin indicates clinically effective in controlling systemic infections both within the respiratory tract and urinary tract, particularly levofloxacin. For this reason, two products had been included in the recommendations of conduct infections developed in recent years. Increasing antibiotic resistance forces to their rational use -in accordance with international guidelines. WSTĘP Wskazaniem do stosowania antybiotyków są stany zapalne wywołane przez drobnoustroje. W zależności od rodzaju patogenu, jego aktywności i wrażliwości na podawany preparat o działaniu hamującym rozwój lub zabijającym bakterie, uzyskuje się odpowiedni efekt kliniczny. Najważniej-szym elementem tego postępowania, poza charakterystyką patogenu, są cechy farmakokinetyczne stosowanego antybiotyku, w tym: jego spektrum działania, stopień penetracji do miejsca toczącego się procesu zapalnego, wykazywane interakcje z innymi cząsteczkami oraz bezpieczeństwo dla chorego [1]. Posiadana wiedza w tym zakresie jest bardzo pomocna przy podejmowaniu decyzji terapeutycznych. KLASYFIKACJA FLUOROCHINOLONÓWChinolony należą do czynników przeciwbakteryjnych zsyntetyzowanych w latach 60. XX wieku w wyniku modyfikacji podstawowej dwupierścieniowej chemicznej struktury. Współczesna klasyfikacja fluorochinolonów jest oparta na spektrum mikrobiologicznym i cechach farmakokinetycznych poszczególnych preparatów. Należy podkreślić, Artyku jest dost pny na zasadzie dozwolonego u ytku osobistego. Dalsze rozpowszechnianie (w tym umieszczanie w sieci) jest zabronione i stanowi powa ne naruszenie przepisów prawa autorskiego oraz grozi sankcjami prawnymi.

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Effectiveness of oral moxifloxacin in standard first-line therapy in community-acquired pneumonia

Cited by 80 publications

References 42 publications

Upgrading antibiotic use within a class: Tradeoff between resistance and treatment success

Upgrading antibiotic use within a class: Tradeoff between resistance and treatment success

Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

Lewofloksacyna i moksyfloksacyna w leczeniu zakażeń bakteryjnych

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