Efficacy and Safety of Sequential IV/PO Moxifloxacin in Comparison to IV Levofloxacin Plus IV Ceftriaxone Followed by PO Levofloxacin, in the Treatment of Patients With Community-acquired Pneumonia

Study Overview
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Brief Summary
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Sequential therapy with intravenous to oral moxifloxacin, was tested at 69 study centres in 17 countries to determine if this treatment regimen is safe and effective in treating hospitalized adult patients with community-acquired pneumonia. 748 patients were participated in the study over an 18 months period. Individual patient involvement in the study was approximately 4-6 weeks. Moxifloxacin was compared to a combination treatment regimen of high dose intravenous ceftriaxone plus high dose intravenous levofloxacin followed by high dose oral levofloxacin.

Official Title
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A Multinational, Prospective, Randomized, Double-blind Study to Investigate the Efficacy and Safety of Sequential Intravenous/Oral Moxifloxacin in Comparison to Intravenous Levofloxacin Plus Intravenous Ceftriaxone Followed by Oral Levofloxacin, in the Treatment of Patients With Severe Community-acquired Pneumonia

Conditions
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Pneumonia

Intervention / Treatment
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* Drug: Avelox (Moxifloxacin, BAY12-8039)
* Drug: Levofloxacin + Ceftriaxone


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged 18 years or above All of the following signs and symptoms of pneumonia: Fever (core/ rectal/ tympanic temperature >/= 38.5°C or axillary/ oral/ cutaneous temperature >/= 38.0°C) or hypothermia (core/ rectal/ tympanic temperature </= 35.5°C or axillary/ oral/ cutaneous temperature </= 35.0°C) White blood cell (WBC) count > 10,000/µL, or >/= 15% immature neutrophils (bands), regardless of the peripheral WBC count, or total WBC count < 4,500/µL The presence of at least 2 of the following symptoms: - Cough- Purulent sputum production Dyspnoea or tachypnoea (respiratory rate > 20 breaths/minute) Rigors and/or chills- Chest pain Auscultatory findings on pulmonary examination of rales/crackles and/or evidence of pulmonary consolidationAND Radiological evidence of (an) infiltrate(s) consistent with bacterial pneumonia at baseline or within 24 hours following enrolment Fine score >/= 71 (i.e. Pneumonia PSI risk Class III, IV or V, requiring hospitalisation for the treatment of CAP) Written informed consent obtained from the patient or a next-of-kin Exclusion Criteria: Known hypersensitivity to fluoroquinolones, or other quinolones, and/or to beta-lactams, or any of the excipients Female patients who are pregnant or lactating History of tendon disease/disorder related to quinolone treatment Known congenital or documented-acquired QT prolongation; concomitant use of drugs, reported to increase the QT interval; uncorrected hypokalaemia; clinically relevant bradycardia; clinically relevant heart failure with reduced left ventricular ejection fraction; previous history of symptomatic arrhythmias History of epilepsy- Known glucose-6-phosphate dehydrogenase deficiency Known severe impaired liver function (i.e. Child Pugh C), (refer to Section 10.4 for definition) or transaminases increase > 5 fold ULN- Hospitalisation for > 48 hours before developing pneumonia, or discharge from hospital < 30 days prior- Systemic antibacterial therapy for more than 24 hours within 14 days of enrolment Patients requiring concomitant systemic antibacterial agents Known structural lung disease (e.g. cystic fibrosis, bronchiectasis, or lung cancer), or other known conditions (e.g. malnutrition) predisposing to infection with nosocomial-like organisms such as Pseudomonas aeruginosa Lung abscess, pleural empyema, risk factors for aspiration pneumonia (e.g. recent stroke, head injury, dementia) Known rapidly fatal underlying disease (death expected within 6 months) Known or suspected active tuberculosis or endemic fungal infection- Neutropenia (neutrophil count < 1,000/µL) caused by immunosuppressive therapy or malignancy Patients known to have AIDS (CD4 count < 200/µL) or HIV-seropositive patients receiving HAART Previous enrolment in this study Participation in any clinical investigational drug study within the previous 4 weeks Patient with pre-terminal renal failure (creatinine clearance < 10 mL/min) and patients undergoing haemodialysis

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Arm 1<br> | Drug: Avelox (Moxifloxacin, BAY12-8039)<br>* Sequential intravenous/oral (400/400 mg once daily for 7 to 14 days) of Avelox (Moxifloxacin, BAY12-8039)<br>|
| Active Comparator: Arm 2<br> | Drug: Levofloxacin + Ceftriaxone<br>* Intravenous combination therapy of levofloxacin 500 mg twice daily and ceftriaxone (2 g once a day) followed by oral levofloxacin (500 mg twice a day for 7 to 14 days).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical response |  | 5 to 7 days after last dose of study medication | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical and bacteriological response |  | At the day of switch from intravenous to oral therapy | 
| Clinical and bacteriological response on treatment |  | At day 3 to 5 | 
| Clinical and bacteriological response |  | At the end of treatment | 
| Bacteriological response |  | 5-7 days after end of treatment | 
| Mortality attributable to pneumonia |  | 5-7 days after end of treatment | 
| Clinical and bacteriological response |  | At days 21 to 28 after end of treatment | 
| Symptoms course of community-acquired pneumonia |  | at defined visits | 
| Adverse Event Collection |  | all visits | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Community-acquired Pneumonia