Moxifloxacin in the treatment of elderly patients with community-acquired pneumonia

Abstract

Elderly patients are at increased risk of developing lower respiratory tract infections compared with younger age groups. A wide spectrum of pathogens may be involved, depending on the patient’s underlying comorbidities and environmental exposure.Streptococcus pneumoniae remains the most common bacterial isolate in community-acquired pneumonia, followed by Haemophilus influenzae, Moraxella catarrhalis and atypical organisms such as Chlamydia pneumoniae, Legionella spp. and Mycoplasma pneumoniae. International guidelines have included the use of the new generation of fluoroquinolones as monotherapy in elderly patients with community-acquired pneumonia. Moxifloxacin is a synthetic fluoroquinolone with a broad spectrum of antimicrobial activity that is approved for use in the treatment of lower respiratory tract infections. Itsin vitro activity is impacted less by mutations in S. pneumoniae than other fluoroquinolones. It has pharmacological characteristics that support once-daily dosing regimens and early conversion from intravenous to oral therapy, allowing for an early hospital discharge and subsequent cost reduction. The drug has an excellent safety profile. Gastrointestinal manifestations are among the most commonly reported adverse events. Moxifloxacin does not appear to have an increased risk of malignant cardiac arrhythmias, but caution is recommended in elderly patients with uncorrected hypokalemia or hypomagnesemia, or those receiving class IA or III antiarrhythmic agents. No dosage adjustments are needed in cases of renal or hepatic impairment.