Oral Trovafloxacin Compared with Amoxicillin (plus Optional Erythromycin) for the Treatment of Mild to Moderate Community-Acquired Pneumonia

Abstract

Pathogens that frequently cause communityacquired pneumonia include Gram-positive (Streptococcus pneumoniae), Gram-negative (Moraxella catarrhalis, Haemophilus influenzae) and atypical respiratory tract pathogens (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila). With most currently available therapies, combination antibiotic therapy is often indicated where an atypical pathogen is suspected, or in the case of more severe infection. The increasing emergence of penicillinand cephalosporin-resistant S. pneumoniae strains,[1] erythromycin-resistant S. pneumoniae strains,[2] and thewidespread occurrence of β-lactamaseproducingH. influenzae andM. catarrhalis strains[3] has intensified the search for novel antibiotics that provide broad spectrum activity against respiratory tract pathogens. Trovafloxacin is a new generation fluoroquinolone that offers good activity in vitro against a broad range of Gram-positive, Gram-negative and atypical respiratory pathogens, and anaerobes,[4-6]including penicillinresistant strains of S. pneumoniae.[7] Trovafloxacin attains high concentrations in the lung, exceeding the MIC90 values of most important respiratory pathogens,[8] and has a long elimination half-life (approximately 11 hours), which allows once-daily administration. Furthermore, special patient groups, such as the elderly, may be given trovafloxacin without dose adjustment.[9] These features suggested that trovafloxacin monotherapy should be effective as once-daily treatment for respiratory tract infections. Accordingly, a study was undertaken to compare the efficacy and safety of trovafloxacin with amoxicillin (+ optional erythromycin) for the oral treatment of adult patients with mild-to-moderate community-acquired pneumonia. Patients and Methods