莫西沙星与左氧氟沙星治疗呼吸道感染的Meta分析

目的比较莫西沙星与左氧氟沙星在治疗呼吸道感染的有效性和安全性。方法应用RevMan5软件对国内1998—2008年发表的运用莫西沙星治疗呼吸道感染的随机对照试验进行meta分析,左氧氟沙星为对照组,结果指标包括临床总有效率、细菌清除率、不良反应发生率。结果检索到18个试验,包括1392例患者。莫西沙星总有效率优于对照组[RR2.24,95%CI（1.64,3.07）;P〈0.00001];细菌清除率优于对照组[RR2.35,95%CI（1.58,3.49）;P〈0.0001];不良反应发生率可能少于对照组。结论现有的证据表明,莫西沙星在治疗呼吸道感染的疗效优于左氧氟沙星。不良反应可能少于左氧氟沙星或两者无差异。     

莫西沙星与左氧氟沙星治疗呼吸道感染的Meta分析

目的 比较莫西沙星与左氧氟沙星在治疗呼吸道感染的有效性和安全性。方法 应用RevMan 5软件对国内1998-2008年发表的运用莫西沙星治疗呼吸道感染的随机对照试验进行meta分析,左氧氟沙星为对照组,结果指标包括临床总有效率、细菌清除率、不良反应发生率。结果 检索到18个试验,包括1 392例患者。莫西沙星总有效率优于对照组[RR 2.24,95% CI(1.64,3.07);P<0.000 01];细菌清除率优于对照组[RR 2.35,95% CI(1.58,3.49);P<0.000 1];不良反应发生率可能少于对照组。结论 现有的证据表明,莫西沙星在治疗呼吸道感染的疗效优于左氧氟沙星。不良反应可能少于左氧氟沙星或两者无差异。     

莫西沙星和左氧氟沙星治疗社区获得性肺炎有效性和安全性的Meta分析

目的:系统评价莫西沙星与左氧氟沙星治疗社区获得性肺炎的有效性及安全性。方法:运用Meta分析法对10项国内外莫西沙星和左氧氟沙星治疗社区获得性肺炎的临床随机对照试验结果进行综合分析。结果:10项研究无明显的异质性(P>0.05),采用固定效应模型,计算痊愈率、有效率、细菌清除率这3项指标的RR值分别为1.15,1.08,1.07(P<0.05),不良反应的RR值为1.00(P>0.05),但是不良反应的数据太少,仍需要扩大样本量来研究。结论:莫西沙星在治疗社区获得性肺炎时,对症状控制、细菌的清除疗效优于左氧氟沙星。     

莫西沙星与左氧氟沙星分别治疗慢性阻塞性肺疾病加重期疗效与安全性的系统评价

目的：系统评价莫西沙星与左氧氟沙星分别治疗慢性阻塞性肺疾病加重期（AECOPD）的临床疗效与安全性,为临床应用提供更优化的方案。方法：计算机检索中国学术期刊全文数据库（CNKI）、万方数据库（WANFANG DATA）、中国生物医学文献数据库,检索时间为2002年至2013年。纳入比较莫西沙星（试验组）与左氧氟沙星（对照组）治疗AECOPD的随机对照试验（RCT）,排除不符合的文献后,使用RevMan5.0软件进行Meta分析。结果：共纳入7个RCT,共计409例慢性阻塞性肺疾病（COPD）患者。在总有效率方面,试验组高于对照组（OR=2.79,95%CI=1.56～5.01,P=0.000 6）;在细菌清除率方面,试验组显著高于对照组（OR=2.27,95%CI=1.23～4.19,P=0.009）。409例患者中,试验组有13例发生不良反应,对照组有22例。结论：莫西沙星治疗AECOPD的总有效率与细菌清除率均显著高于左氧氟沙星,且不良反应较少,可以考虑用莫西沙星代替左氧氟沙星用于AECOPD的治疗。     

左氧氟沙星联合常规四联化疗方案治疗复治涂阳肺结核疗效及安全性的Meta分析

目的 采用Meta分析法评价左氧氟沙星联合常规四联化疗方案治疗复治涂阳肺结核的疗效及安全性。方法 计算机检索中国知网、万方数据知识服务平台、维普网等中文数据库中公开发表的左氧氟沙星联合常规化疗方案治疗复治涂阳肺结核的相关文献,时间限定为建库起至2022年8月。对照组采用利福平+异烟肼+吡嗪酰胺+乙胺丁醇常规化疗方案,试验组在对照组基础上加用左氧氟沙星。提取纳入文献的资料,采用Cochrane评价法评价纳入文献的质量,采用Stata MP 15及RevMan 5.3软件进行Meta分析。结果 最终纳入23篇文献,共包含1 793例患者,各文献的选择偏倚均为低风险。Meta分析结果显示,试验组总有效率[RR=3.66,95%CI(2.78,4.82)]、痰菌转阴率[RR=1.33,95%CI(1.25,1.41)]、空洞闭合率[RR=1.50,95%CI(1.31,1.71)]、病灶总吸收率[RR=1.28,95%CI(1.21,1.36)]高于对照组(P<0.05),不良反应发生率低于对照组[RR=0.46,95%CI(0.34,0.60),P<0.05]。漏斗图结果显示,报...     

莫西沙星治疗难治复治多耐药肺结核的系统评价

目的 系统评价莫西沙星联合抗结核药物治疗复治肺结核的疗效与安全性。方法 检索Medline(1950—2009)、外文全文生物医学期刊(FJIS,1995—2008)、中国医院数字图书馆(CNKI,1994—2008)、中国生物医学文献数据库(CBMdisc,1977—2008)、WHO EML等数据库和网站中所有莫西沙星治疗难治复治多耐药肺结核随机对照临床试验,按照《药品文献评价指导原则》同时采用Cochrane协作网提供的RevMan 4.2.10软件分析数据。结果 最终纳入7个RCT。Meta分析结果显示,莫西沙星治疗组与对照组相比,痰菌转阴率[RR=1.11,95%CI(1.03,1.19)],临床有效率[RR=1.14,95%CI(1.04,1.25)]的差异均有统计学意义。结论 现有证据表明,莫西沙星用于难治、复治、多耐药肺结核治疗,有助于痰菌转阴。     

莫西沙星与左氧氟沙星治疗尿路感染有效性与安全性Meta分析

目的：对莫西沙星与左氧氟沙星治疗尿路感染的临床效果进行评价,为临床应用提供循证医学证据.方法：以“莫西沙星”、“左氧氟沙星”、“尿路感染”等为主题词或关键词全面查询国内发表文献的数据库,运用RevMan5.1软件对符合条件的结果进行分析.结果：共纳入12篇文献,总样本量1110例,Meta分析结果为有效性、治愈率、不良反应发生率及细菌清除率的合并OR值分别为1.81（P=0.01）、1.67（P=0.002）、0.75（P=0.21）、1.70（P=0.10）.结果提示莫西沙星的疗效优于左氧氟沙星,不良反应发生率及细菌清除率与左氧氟沙星相比差异无统计学意义.针对莫西沙星口服及静脉两种给药方法进行亚组分析,结果提示口服给予莫西沙星治疗尿路感染的有效率及治愈率高于左氧氟沙星,而静脉给予莫西沙星有效率及治愈率与左氧氟沙星相比差异无统计学意义.结论：在尿路感染治疗中,莫西沙星较左氧氟沙星疗效好,安全性好,但由于样本量小、研究质量不高、方法描述不详等,只能为临床研究提供低强度证据.     

莫西沙星序贯治疗社区获得性肺炎的Meta分析

目的:系统评价莫西沙星序贯治疗社区获得性肺炎的临床有效性和安全性。方法:采用计算机和手工检索相结合的方法,检索2005年1月～2012年11月国内公开发表的莫西沙星序贯治疗社区获得性肺炎的相关文献,采用RevMan 5.0对符合条件的文献进行Meta分析。结果:共有9篇文献,815例患者满足纳入标准。Meta-分析结果显示,莫西沙星序贯治疗社区获得性肺炎与对照组比较,临床有效率方面的OR为0.74,95%CI为(0.46,1.16);细菌清除率方面的OR为0.80,95%CI为(0.41,1.56);不良反应发生率方面的OR为0.59,95%CI为(0.35,0.99)。结论:莫西沙星序贯治疗社区获得性肺炎的临床有效率与细菌清除率与对照组相似,但不良反应少于对照组,但本次研究仍有局限性,需大样本多中心随机对照临床试验进一步证实。     

莫西沙星与左氧氟沙星治疗细菌感染的Meta分析

目的比较莫西沙星与左氧氟沙星用于细菌感染治疗的有效性和安全性。方法使用计算机检索万方、CNKI、CBM、Pubmed以及ScienceDirect等文献数据库收集2005²013年发表的使用莫西沙星治疗细菌感染的随机对照试验,左氧氟沙星作为对照组,使用RevMan软件对符合纳入标准的研究结果进行Meta分析。结果共纳入文献12篇,包括患者1 706例。莫西沙星总有效率高于对照组;不良反应发生率有可能低于对照组。结论通过对现有研究结果的分析,说明莫西沙星在用于治疗细菌感染时其疗效要高于左氧氟沙星,不良反应有可能低于左氧氟沙星或两者无显著差异。     

莫西沙星治疗复杂腹腔感染的疗效和安全性的Meta分析

目的:比较莫西沙星与其他抗菌药物治疗复杂腹腔感染的有效性和安全性。方法:计算机检索Cochrane图书馆、Pubmed,EMBASE,CBM,CNKI以及万方等文献数据库(检索时间截止到2011年11月),纳入符合要求的临床随机对照研究,采用RevMan 5.0软件进行Meta分析。结果:共纳入6篇文献,2 372例患者。莫西沙星组的临床治愈率明显高于头孢哌酮舒巴坦联合左氧氟沙星组(P=0.03),而与头孢曲松联合甲硝唑、哌拉西林他唑巴坦、单用厄他培南等药物组无统计学差异。莫西沙星组与其他药物组细菌清除率无统计学差异。安全性方面,莫西沙星组的不良反应发生率略高于头孢曲松钠联用甲硝唑组(P=0.006),而与其他药物组无显著差异。结论:莫西沙星治疗复杂腹腔感染的有效性高于头孢哌酮舒巴坦联合左氧氟沙星组,安全性低于头孢曲松钠联用甲硝唑组。     

高剂量左氧氟沙星治疗老年下呼吸道感染的疗效分析

目的:评价高剂量左氧氟沙星注射液治疗老年下呼吸道感染的临床疗效及安全性。方法:60例老年下呼吸道细菌感染患者,分为试验组(左氧氟沙星500mg静脉滴注,1次.d-1)与对照组(莫西沙星400mg静脉滴注,1次.d-1),疗程7~14d。结果:试验组与对照组对咳嗽、咳痰、发热、外周血白细胞恢复的有效率均在80.00%以上,临床总有效率分别为90.00%、86.67%,细菌清除率分别为76.92%、81.25%,2组疗效比较差异无统计学意义;药品不良反应发生率分别为16.67%、13.33%,2组间差异无统计学意义。结论:高剂量左氧氟沙星治疗老年下呼吸道感染安全、有效。     

Moxifloxacin versus levofloxacin for treatment of acute rhinosinusitis: a retrospective database analysis of treatment duration, outcomes, and charges

OBJECTIVE: Antibiotics are clinically indicated for acute bacterial rhinosinusitis, but they may be prescribed inappropriately. This retrospective study examined how labeled recommendations for duration of moxifloxacin and levofloxacin treatment of acute bacterial rhinosinusitis compare with real-world practice, and compared the failure and recurrence rates, and associated charges. METHODS AND MAIN OUTCOME MEASURES: The PharMetrics Patient-Centric claims database was searched over a 3-year period for episodes of acute rhinosinusitis treated within 5 days with moxifloxacin or levofloxacin. The duration of antibiotic treatment prescribed was compared with the labeled recommendation. Failure rates (a second antibiotic claim to treat acute rhinosinusitis within 30 days of the first claim), recurrence rates (subsequent antibiotic claims to treat any rhinosinusitis more than 30 days after the original or second [in the case of failure] claim), and treatment charges from the perspective of the payer (health insurer) were also compared using multivariate analysis. RESULTS: The initial duration prescribed of moxifloxacin was shorter than for levofloxacin (-1.65 days, p < 0.0001), reflecting the shorter labeled recommendation (10 days versus 10-14 days). The durations of monotherapy (-2.06 days, p < 0.0001) and of all antibiotic treatment (-1.97 days, p < 0.0001) were also significantly shorter for episodes treated initially with moxifloxacin. The odds ratio for treatment failure (0.718; 95% confidence interval = 0.598-0.863; p = 0.0004) and the hazard ratio for recurrence (0.652; p = 0.0005) were both significantly lower for moxifloxacin than for levofloxacin, and resulted in lower total treatment charges (-$37.94 +/- 13.65; p = 0.0055). CONCLUSION: The shorter treatment durations seen for moxifloxacin in this database of real-world care reflect the label-recommended duration for acute rhinosinusitis. Despite this shorter duration of therapy, moxifloxacin resulted in better outcomes than levofloxacin in terms of the risk of treatment failure and recurrence. In addition, the total charges were lower for patients treated with moxifloxacin.     

左氧氟沙星治疗下呼吸道感染两种治疗方案的决策树分析

目的:评价左氧氟沙星治疗下呼吸道感染两种方案的经济效果。方法:选择40例下呼吸道感染病例,分为左氧氟沙星静滴组(A组)、左氧氟沙星静滴-口服序惯疗法组(B组),观察临床治疗效果,并利用决策树分析模型进行成本-效果分析。结果:左氧氟沙星静滴组和左氧氟沙星静滴-口服序惯疗法组总成本分别为1081.20、773.28元(P<0.05);两组治疗有效率分别为85.7%和84.2%(P>0.05)。结论:左氧氟沙星静滴-口服序惯疗法治疗下呼吸道感染与单纯静滴给药疗效相当,但更为经济。     

左氧氟沙星治疗成人下呼吸道感染两种方案的经济学分析

目的:探讨左氧氟沙星治疗成人下呼吸道感染两种方案的经济效果。方法:将60例下呼吸道感染患者随机分为左氧氟沙星静脉滴注组和左氧氟沙星静脉-口服序贯疗法组,观察临床疗效并作成本-效果分析。结果:左氧氟沙星静脉滴注组与左氧氟沙星静脉-口服序贯疗法组总成本分别为688.8元、417.3元(P<0.05),疗效分别为86.4％、85.1％(P>0.05)。结论:左氧氟沙星静脉-口服序贯疗法是治疗成人下呼吸道感染的较佳方案。     

莫西沙星治疗老年社区获得性肺炎临床研究

目的探讨莫西沙星治疗老年社区获得性肺炎的临床疗效。方法 100例患者,将其分为对照组(50例)与观察组(50例),两组患者的疗程均为10 d,对照组给予1次/d静脉连续点滴左氧氟沙星(400 mg),观察组给予1次/d静脉连续点滴莫西沙星注射液(400 mg),患者症状明显改善后改为1次/d口服莫西沙星片(400 mg)。观察莫西沙星治疗老年社区获得性肺炎的临床疗效。结果观察组的临床疗效明显高于对照组,差异有统计学意义(χ2=8.21,P<0.05)。观察组的细菌疗效明显高于对照组,差异有统计学意义(χ2=7.18,P<0.05)。两组患者均有患者出现,两组间副反应发生率差异无统计学意义(P>0.05)。副反应均较轻,患者可耐受,不影响治疗,经对症处理后缓解。结论莫西沙星治疗老年社区获得性肺炎疗效显著,值得临床推广应用。     

A cost-minimisation analysis comparing moxifloxacin with levofloxacin plus ceftriaxone for the treatment of patients with community-acquired pneumonia in Germany: results from the MOTIV trial

ABSTRACT

Objective: This study presents a cost-minimisation analysis of moxifloxacin compared to combination treatment with levofloxacin and ceftriaxone in patients hospitalised with community-acquired pneumonia (CAP) in Germany.

Research design and methods: In the MOTIV study, 738 adult patients with CAP requiring hospitalisation and initial parenteral antibiotic therapy were randomised to sequential IV/oral therapy with either moxifloxacin (n?=?368), or levofloxacin and ceftriaxone (n?=?365). The primary effectiveness endpoint was the proportion of patients demonstrating clinical improvement 5–7 days after the completion of study treatment. Subgroup analysis considered patients with severe CAP according to pneumonia severity index (PSI) risk class IV and V, microbiologically proven infection, a history of chronic obstructive pulmonary disease, and a history of cardiovascular disease. The analysis included the cost of study medication, hospital stay, readmission and inpatient procedures and diagnostics. Event frequency in the study was multiplied by German unit costs to estimate per-patient expenditure. The analysis was conducted from a hospital perspective. Sensitivity analysis investigated the effect of costing from an insurer perspective.

Results: No significant difference was found in the percentage of successfully treated patients. Average per patient cost was €2190 for the moxifloxacin group, and €2619 for the levofloxacin + ceftriaxone group (difference –€430, 95% CI: –€138, –€740; p?<?0.05). Variability in total costs was wide, with some patients accruing up to €18?000. Medication cost was significantly lower with moxifloxacin than levofloxacin + ceftriaxone (–€470, 95% CI: –€522, –€421), and accounted for between 15 and 30% of total costs.

Conclusions: In this analysis of patients hospitalised with CAP in Germany, treatment with moxifloxacin was significantly less costly than treatment with levofloxacin and ceftriaxone.     

Hospital visits and costs following outpatient treatment of CAP with levofloxacin or moxifloxacin

Abstract

Background:

Hospital admissions (inpatient and emergency room) are a major source of medical costs for community-acquired pneumonia (CAP) initially treated in the outpatient setting. Current CAP treatment guidelines do not differentiate between outpatient treatment with levofloxacin and moxifloxacin.     

A critical review of the fluoroquinolones: focus on respiratory infections.

The new fluoroquinolones (clinafloxacin, gatifloxacin, gemifloxacin, grepafloxacin, levofloxacin, moxifloxacin, sitafloxacin, sparfloxacin and trovafloxacin) offer excellent activity against Gram-negative bacilli and improved Gram-positive activity (e.g. against Streptococcus pneumoniae and Staphylococcus aureus) over ciprofloxacin. Ciprofloxacin still maintains the best in vitro activity against Pseudomonas aeruginosa. Clinafloxacin, gatifloxacin, moxifloxacin, sitafloxacin, sparfloxacin and trovafloxacin display improved activity against anaerobes (e.g. Bacteroides fragilis) versus ciprofloxacin. All of the new fluoroquinolones display excellent bioavailability and have longer serum half-lives than ciprofloxacin allowing for once daily dose administration. Clinical trials comparing the new fluoroquinolones to each other or to standard therapy have demonstrated good efficacy in a variety of community-acquired respiratory infections (e.g. pneumonia, acute exacerbations of chronic bronchitis and acute sinusitis). Limited data suggest that the new fluoroquinolones as a class may lead to better outcomes in community-acquired pneumonia and acute exacerbations of chronic bronchitis versus comparators. Several of these agents have either been withdrawn from the market, had their use severely restricted because of adverse effects (clinafloxacin because of phototoxicity and hypoglycaemia; grepafloxacin because of prolongation of the QTc and resultant torsades de pointes; sparfloxacin because of phototoxicity; and trovafloxacin because of hepatotoxicity), or were discontinued during developmental phases. The remaining fluoroquinolones such as gatifloxacin, gemifloxacin, levofloxacin and moxifloxacin have adverse effect profiles similar to ciprofloxacin. Extensive post-marketing safety surveillance data (as are available with ciprofloxacin and levofloxacin) are required for all new fluoroquinolones before safety can be definitively established. Drug interactions are limited; however, all fluoroquinolones interact with metal ion containing drugs (eg. antacids). The new fluoroquinolones (gatifloxacin, gemifloxacin, levofloxacin and moxifloxacin) offer several advantages over ciprofloxacin and are emerging as important therapeutic agents in the treatment of community-acquired respiratory infections. Their broad spectrum of activity which includes respiratory pathogens such as penicillin and macrolide resistant S. pneumoniae, favourable pharmacokinetic parameters, good bacteriological and clinical efficacy will lead to growing use of these agents in the treatment of community-acquired pneumonia, acute exacerbations of chronic bronchitis and acute sinusitis. These agents may result in cost savings especially in situations where, because of their potent broad-spectrum activity and excellent bioavailability, they may be used orally in place of intravenous antibacterials. Prudent use of the new fluoroquinolones will be required to minimise the development of resistance to these agents.     

Moxifloxacin versus levofloxacin for treatment of acute rhinosinusitis: a retrospective database analysis of treatment duration,outcomes, and charges

ABSTRACT

Objective: Antibiotics are clinically indicated for acute bacterial rhinosinusitis, but they may be prescribed inappropriately. This retrospective study examined how labeled recommendations for duration of moxifloxacin and levofloxacin treatment of acute bacterial rhinosinusitis compare with real-world practice, and compared the failure and recurrence rates, and associated charges.

Methods and main outcome measures: The PharMetrics Patient-Centric claims database was searched over a 3‐year period for episodes of acute rhinosinusitis treated within 5 days with moxifloxacin or levofloxacin. The duration of antibiotic treatment prescribed was compared with the labeled recommendation. Failure rates (a second antibiotic claim to treat acute rhinosinusitis within 30 days of the first claim), recurrence rates (subsequent antibiotic claims to treat any rhinosinusitis more than 30 days after the original or second [in the case of failure] claim), and treatment charges from the perspective of the payer (health insurer) were also compared using multivariate analysis.

Results: The initial duration prescribed of moxifloxacin was shorter than for levofloxacin (–1.65 days, p < 0.0001), reflecting the shorter labeled recommendation (10 days versus 10–14 days). The durations of monotherapy (–2.06 days, p < 0.0001) and of all antibiotic treatment (–1.97 days, p < 0.0001) were also significantly shorter for episodes treated initially with moxifloxacin. The odds ratio for treatment failure (0.718; 95% confidence interval = 0.598–0.863; p = 0.0004) and the hazard ratio for recurrence (0.652; p = 0.0005) were both significantly lower for moxifloxacin than for levofloxacin, and resulted in lower total treatment charges (–$37.94 ± 13.65; p = 0.0055).

Conclusion: The shorter treatment durations seen for moxifloxacin in this database of real-world care reflect the label-recommended duration for acute rhinosinusitis. Despite this shorter duration of therapy, moxifloxacin resulted in better outcomes than levofloxacin in terms of the risk of treatment failure and recurrence. In addition, the total charges were lower for patients treated with moxifloxacin.