Treatment with Moxifloxacin versus Standard Therapy for Community‐Acquired Pneumonia
Abstract
To the Editor—It is difficult to escape the conclusion that the study reported by Welte et al. [1] was intended more to promote the superiority of moxifloxacin than to provide a balanced evaluation of options for the treatment of community-acquired pneumonia (CAP). First, since publication of a retrospective study by Gleason et al. [2] in 1999, many guidelines for the treatment of CAP, including those published by the Infectious Diseases Society of America [3], have recommended that empirical therapy include a regimen that is active against atypical pathogens. Because Welte and colleagues compared moxifloxacin to ceftriaxone with or without erythromycin (CTRX ± ERY), and because only 37.8% of patients actually received erythromycin, the deck seems stacked in favor of moxifloxacin. Similarly, data on the duration of hospitalization were almost guaranteed to favor moxifloxacin, which in fact they did, because patients in the moxifloxacin group could have their regimens switched to oral therapy, whereas those in the CTRX ± ERY group could not. Finally, how else can we interpret the statement that “there was a nonsignificant trend toward a higher rate of clinical resolution of class IV and V pneumonia symptoms in the [moxifloxacin] group, compared with the CTRX ± ERY group (77.8% [21 of 27 patients] vs. 70.4% [19 of 27 patients]; P = .534) and among patients aged >74 years (81.5% [22 of 27 patients] vs. 70.6% [24 of 34 patients]; P = .326)” [1, p. 1701]? It is difficult to see…
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