Experts attending the 5^th International Moxifloxacin Symposium agreed that the intravenous form of moxifloxacin was likely to become the new 'gold standard' for the treatment of patients hospitalized with community-acquired pneumonia (CAP), due to it's clinical superiority, shorter duration and hospitalisation, and higher survival rates for patients.

PARIS, FRANCE, November 16, 2001 -  Experts attending the 5^th International Moxifloxacin Symposium, agreed that the intravenous form of moxifloxacin was likely to become the new 'gold standard' for the treatment of patients hospitalized with community-acquired pneumonia (CAP), due to it's clinical superiority, shorter duration and hospitalisation, and higher survival rates for patients.

Illustrating the impact that CAP has on the community, Professor Hartmut Lode, Chief of the Department of Chest and Infectious Diseases, Heckeshorn Hospital, Free University, Berlin, Germany, explained that although CAP is treated predominantly out of the hospital, it still incurs significant health care expenditure and is a frequent cause of morbidity and mortality world-wide. Every year there are over 3 million cases of CAP in Europe, and an estimated 2-3 million in the USA. Of these, up to 20% will be hospitalized. However the economic impact of CAP is still largely underestimated, and in the US alone, it was calculated at more than $9 billion in 1994. "Clearly patients and healthcare systems would benefit if patients can be appropriately treated out of the hospital or discharged sooner", he said.

Of particular concern was the data he presented which showed that patients who are hospitalized with CAP need to be effectively treated from the outset. The results showed a clear correlation between inappropriate initial therapy and increased mortality. In addition, inadequate initial therapy also had an impact on the emergence of infections due to antibiotic-resistant bacteria.

"Moxifloxacin's rapidly bactericidal activity may achieve faster symptom relief enabling patients to return to normal activities sooner. In addition, antimicrobial resistance has made the new fluoroquinolones, such as moxifloxacin, a particularly attractive therapeutic option," he said. "With the availability of both IV and oral formulations of moxifloxacin, this 'respiratory' fluoroquinolone is a potential first-line option in certain patient groups," he concluded.

Assessing the safety and efficacy of intravenous moxifloxacin in hospitalized CAP patients, Dr Javier Garau, Head of the Department of Medicine, University of Barcelona, Spain, presented data from two multicentre studies.

The first, a European study, evaluated the efficacy and safety of sequential IV/oral moxifloxacin (400 mg once daily) compared to the European Respiratory Society (ERS) standard of amoxicillin/clavulanic acid and/or clarithromycin in over 500 patients. Moxifloxacin IV, as monotherapy, was statistically superior to the ERS standard in terms of clinical response; 93% vs. 85%. In addition, patients treated with moxifloxacin IV recovered more quickly from fever. Bacteriologically, patients responded better with moxifloxacin IV, 94% vs. 82%.

In a second North American study, moxifloxacin IV was found to be equivalent to trovafloxacin IV or levofloxacin IV therapy. Of the 550 moxifloxacin-treated patients 33 % reported adverse events of cases compared to 31% in the comparator group. The main clinical adverse events were diarrhoea and nausea. "Together, these studies demonstrate that moxifloxacin IV is well-tolerated, convenient, clinically effective, and could become the new 'gold standard' therapy, replacing a combination of a beta-lactam and a macrolide," Dr Garau concluded.

Commenting on the need to re-evaluate our approach to the use of antibiotics, Dr Antonio Torres, Head of the Department of Medicine, Hospital Mutua de Terrassa, Barcelona, Spain, explained that the clinical development of new antimicrobials is based on the evaluation of a response of some 10-14 days after treatment has started. "This is far too late to observe if any real difference in ability to eradicate the causative organism has occurred. We need to start examining new parameters earlier in the disease process, using standard physiological markers such as fever and blood pressure. "Some of these may have been changing more rapidly with the faster killing drugs, like moxifloxacin, long before the 10 days measurements were taken," he concluded.

Joseph Blondeau, Clinical Assistant Professor of Pathology, Adjunct Professor of Microbiology at the University of Saskatchewan and Head of Clinical Microbiology for Saskatoon, commented on 'Mutant Prevention Concentration' (MPC) - a new parameter which may prove very useful in assessing the usefulness of an antibiotic, both in the hospital and community. Professor Blondeau explained, "The MPC is defined as the concentration of an antibiotic at which no selection of resistant organisms of a given bacterial species occurs. It is very likely that in future dosing antibiotics above MPCs will be an important consideration when selecting an antimicrobial agent." Commenting on the ability of moxifloxacin to prevent resistant strains of S. Pneumoniae developing in CAP, Professor Blondeau said, "Streptococcus pneumoniae is the commonest bacterial cause of CAP, and the MPC of moxifloxacin against this pathogen is 1ug/ml. So far, moxifloxacin is the only quinolone tested to date where the drug concentration remains above the MPC for the full 24 hour dosing interval. This significantly reduces the likelihood that resistant strains will be selected," he concluded.

Summing up the session on moxifloxacin IV, Professor Richard Wise, University of Birmingham and Consultant Medical Microbiologist at City Hospital, United Kingdom, said, "To meet the growing burden of respiratory tract infections, new agents continue to be developed, forcing us to reconsider how best to assess them and use them so that we can preserve their activity. Moxifloxacin IV has been developed in a careful, progressive manner. In keeping with its promise as the 'ideal respiratory antibiotic,' moxifloxacin IV has been developed initially for the treatment of community-acquired pneumonia. However, this drug has clear potential for the treatment of other infections, as experience and confidence grow", he concluded.

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