Kyuho Kim, Mercer University College of Pharmacy
Community-acquired pneumonia (CAP) is stated to be a major cause of morbidity and mortality in the United States, and one fifth of whom require hospitalization. 
According to the Infectious Diseases Society of America and the American Thoracic Society (IDSA/ATS) 2007 guidelines, either a fluoroquinolone or a beta-lactam plus a macrolide is recommended for CAP in non–intensive care unit (ICU) inpatients, and it is stated that most admitted patients are given intravenous (IV) formulations of these medications. 
|Association between initial route of fluoroquinolone administration and outcomes in patients hospitalized for community-acquired pneumonia (CAP)|
|Design||Retrospective cohort study; N= 36,405|
|Objective||To compare outcomes of hospitalized CAP patients initially receiving intravenous (IV) vs oral respiratory fluoroquinolones|
|Study Groups||Intravenous fluoroquinolone (n= 34,200); oral fluoroquinolone (n= 2,205)|
|Methods||Data from 340 hospitals involving CAP patients admitted to a non–intensive care unit (ICU) setting from 2007 to 2010, who received intravenous or oral levofloxacin or moxifloxacin|
|Duration||July 2007 to June 2010|
|Primary Outcome Measure||In-hospital mortality|
|Oral fluoroquinolone||Intravenous fluoroquinolone|
|Pneumonia/influenza||1,942 (88.1)||29,304 (85.7)|
|Sepsis||150 (6.8)||3,325 (9.7)|
|Respiratory failure||113 (5.1)||1,571 (4.6)|
|Levofloxacin||1,536 (74.1)||24,060 (72.4)|
|Moxifloxacin||537 (25.9)||9,175 (27.6)|
|Results||Oral fluoroquinolone||Intravenous fluoroquinolone||p value|
|Adverse Events||Common Adverse Events: N/A|
|Serious Adverse Events: N/A|
|Percentage that Discontinued due to Adverse Events: N/A|
|Study Author Conclusions||Among hospitalized patients who received fluoroquinolones for CAP, there was no association between initial route of administration and outcomes. More patients may be treated orally without worsening outcomes.|
While the study aims to compare results of hospitalized CAP patients initially receiving intravenous (IV) or oral respiratory fluoroquinolones, there were certain limitations including the fact that the IV fluoroquinolone patients had more severe CAP than the oral fluoroquniolone patients.
As respiratory fluoroquinolones have the same intravenous and oral bioavailability and because more patients are treated with oral fluoroquinolones without worsening outcomes, further studies may be warranted given that starting with oral therapy was not inferior to beginning with IV therapy.
- Frei CR, Labreche MJ, Attridge RT. Fluoroquinolones in community-acquired pneumonia: guide to selection and appropriate use. Drugs 2011; 71:757–70.
- Mandell LA, Wunderink RG, Anzueto A et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(suppl 2):S27–72.