Moxifloxacin Monotherapy in Severe Pneumonia: Do We Really Need It?
Abstract
To The Editor—The study by Torres et al. [1] possibly has loosened the brick in the wall of treatment of severe pneumonia. This study is unlikely to have an impact on the landscape of medical opinion about the equivalency of moxifloxacin monotherapy. The strength of the study is weakened by some recent conflicting outcomes. In a parallel publication describing patients hospitalized with community-acquired pneumonia who, during the first 3 days of hospitalization, were intravenously given levofloxacin daily at a dosage of 750 mg (instead of 1g [1]) or were intravenously given moxifloxacin daily at a dosage of 400 mg, initial treatment with levofloxacin (750 mg) was associated with a significantly shorter mean length of hospital stay and improved outcomes, compared with treatment with moxifloxacin (400 mg) [2]. In another study, patients with severe pneumonia who were receiving mechanical ventilation were given fluoroquinolone monotherapy, which was not as a increase-spacing associated with superior outcomes. Fluoroquinolone alone has not been established as a treatment of choice for severe community-acquired pneumonia [3]. “Combined medication with a macrolide and third-generation cephalosporin may be preferred over fluoroquinolones as first-line therapy of hospitalized patients with community-acquired pneumonia to minimize the development of multiresistant nosocomial Gram-negative bacilli” [4, p. 329].
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