Moxifloxacin versus Levofloxacin for Acute Exacerbation of Chronic Obstructive Pulmonary Diseases: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Xiaohu ,  LIU Xiaoju

Department of Geriatric Respiratory, the First Hospital of Lanzhou University, Lanzhou 730000, China;

Corresponding author：

LIU Xiaoju, Email: liu_xiaoju@yahoo.com.cn

Keywords：

Acute exacerbation of chronic obstructive pulmonary diseases; Moxifloxacin; Levofloxacin; Randomized controlled trial; Meta-analysis; Systematic review

DOI：

10.7507/1672-2531.20120113

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To assess the effectiveness and safety of moxifloxacin versus levofloxacin for the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
Methods Such databases as PubMed, EMbase, The Cochrane Library, CBM, CNKI and VIP were electronically searched, and the relevant conference proceedings were also hand-searched. The search time was up to July, 2011. Randomized controlled trials (RCTs) on moxifloxacin versus levofloxacin for AECOPD were included. Literature was screened according to inclusive and exclusive criteria, data were extracted, quality was assessed, and then meta-analysis was performed using RevMan 5.0.
Results A total of 6 RCTs involving 482 patients with AECOPD were included. The results of meta-analysis showed that moxifloxacin group was significantly superior to levofloxacin group in the effective rate (OR=3.15, 95%CI 1.80 to 5.49, P lt;0.000 1). The bacterial clearance rate in moxifloxacin group was also higher than that in the levofloxacin group (OR=2.79, 95%CI 1.30 to 5.97, P=0.008). In addition, adverse effects of moxifloxacin group were less than levofloxacin (OR=0.48, 95%CI 0.24 to 0.98, P=0.04).
Conclusion Based on current studies, moxifloxacin is superior to levofloxacin in improving effective rate and bacterial clearance rate, and in lowering side effects when treating AECOPD. Hence it is considerable to use moxifloxacin instead of levofloxacin in the treatment of AECOPD if necessary. Due to the limitation of both quantity and quality of included studies, this conclusion should be further confirmed with more high quality and large sample studies.

Citation： WANG Xiaohu,LIU Xiaoju. Moxifloxacin versus Levofloxacin for Acute Exacerbation of Chronic Obstructive Pulmonary Diseases: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(6): 694-699. doi: 10.7507/1672-2531.20120113 Copy

1.	Sethi S, Mallia P, Johnston SL. New paradigms in the pathogenesis of chronic obstructive pulmonary disease II. Proc Am Thorac Soc, 2009, 6(6): 532-534.
2.	Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med, 2008, 359(22): 2355-2365.
3.	Miravitlles M, Anzueto A. Moxifloxacin: a respiratory fluoroquinolone. Expert Opin Pharmacother, 2008, 9(10): 1755-1772.
4.	Higgins J, Green S. Cochrane Handbook for Systematic Review of Interventions Version 5.0.1[updated September 2009]. The Cochrane Collaboration, 2009: Available from www.cochranehandbook.org.
5.	林森, 吴波, 刘鸣. 醒脑静注射液治疗脑出血的系统评价. 中国循证医学杂志 2008, 8(2): 93-96.
6.	胡家安，高蓓莉, 邓伟吾. 短期口服莫西沙星与静注左氧氟沙星治疗老年COPD急性加重的疗效. 中华临床医学, 2004, 5(10): 12-14.
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9.	梁钢. 莫西沙星治疗慢性阻塞性肺疾病急性加重期效果评价. 山东医药, 2009, 49(25): 74-75.
10.	刘素艳. 莫西沙星治疗慢性阻塞性肺疾病急性加重期疗效观察. 河北医药, 2010, 32(23): 3337-3338.
11.	黄雪英. 莫西沙星治疗慢性阻塞性肺疾病急性加重期临床观察. 现代预防医学, 2010, 37(12): 2386-2387.
12.	Patel IS, Seemungal TA, Wilks M, et al. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax, 2002, 57(9): 759-764.
13.	Rothberg MB, Pekow PS, Lahti M, et al. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA, 2010, 303(20): 2035-2042.
14.	和培红, 郭代红, 周筱青. 第四代喹诺酮类药物研究新进展. 中国新药杂志, 2004, 13(12):1102-1105.
15.	Miravitlles M, Marin A, Monso E, et al. Efficacy of moxifloxacin in the treatment of bronchial colonisation in COPD. Eur Respir J, 2009, 34(5): 1066-1071.
16.	Miravitlles M, Zalacain R, Murio C, et al. Speed of recovery from acute exacerbations of chronic obstructive pulmonary disease after treatment with antimicrobials: results of a two-year study. Clin Drug Investig, 2003, 23(7): 439-450.
17.	Urueta-Robledo J, Ariza H, Jardim JR, et al. Moxifloxacin versus levofloxacin against acute exacerbations of chronic bronchitis: the Latin American Cohort. Respir Med, 2006, 100(9): 1504-1511.
18.	Friedman H, Song X, Crespi S, et al. Comparative analysis of length of stay, total costs, and treatment success between intravenous moxifloxacin 400 mg and levofloxacin 750 mg among hospitalized patients with community-acquired pneumonia. Value Health, 2009, 12(8): 1135-1143.

1. Sethi S, Mallia P, Johnston SL. New paradigms in the pathogenesis of chronic obstructive pulmonary disease II. Proc Am Thorac Soc, 2009, 6(6): 532-534.
2. Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med, 2008, 359(22): 2355-2365.
3. Miravitlles M, Anzueto A. Moxifloxacin: a respiratory fluoroquinolone. Expert Opin Pharmacother, 2008, 9(10): 1755-1772.
4. Higgins J, Green S. Cochrane Handbook for Systematic Review of Interventions Version 5.0.1[updated September 2009]. The Cochrane Collaboration, 2009: Available from www.cochranehandbook.org.
5. 林森, 吴波, 刘鸣. 醒脑静注射液治疗脑出血的系统评价. 中国循证医学杂志 2008, 8(2): 93-96.
6. 胡家安，高蓓莉, 邓伟吾. 短期口服莫西沙星与静注左氧氟沙星治疗老年COPD急性加重的疗效. 中华临床医学, 2004, 5(10): 12-14.
7. 陈钢, 朱凡特. 莫西沙星治疗慢性阻塞性肺疾病急性加重疗效观察. 临床肺科杂志, 2006,11(4):542-543.
8. 罗文姣. 莫西沙星治疗慢性阻塞性肺疾病急性加重期的临床分析. 中国当代医药, 2009, 16(14): 19-21.
9. 梁钢. 莫西沙星治疗慢性阻塞性肺疾病急性加重期效果评价. 山东医药, 2009, 49(25): 74-75.
10. 刘素艳. 莫西沙星治疗慢性阻塞性肺疾病急性加重期疗效观察. 河北医药, 2010, 32(23): 3337-3338.
11. 黄雪英. 莫西沙星治疗慢性阻塞性肺疾病急性加重期临床观察. 现代预防医学, 2010, 37(12): 2386-2387.
12. Patel IS, Seemungal TA, Wilks M, et al. Relationship between bacterial colonisation and the frequency, character, and severity of COPD exacerbations. Thorax, 2002, 57(9): 759-764.
13. Rothberg MB, Pekow PS, Lahti M, et al. Antibiotic therapy and treatment failure in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. JAMA, 2010, 303(20): 2035-2042.
14. 和培红, 郭代红, 周筱青. 第四代喹诺酮类药物研究新进展. 中国新药杂志, 2004, 13(12):1102-1105.
15. Miravitlles M, Marin A, Monso E, et al. Efficacy of moxifloxacin in the treatment of bronchial colonisation in COPD. Eur Respir J, 2009, 34(5): 1066-1071.
16. Miravitlles M, Zalacain R, Murio C, et al. Speed of recovery from acute exacerbations of chronic obstructive pulmonary disease after treatment with antimicrobials: results of a two-year study. Clin Drug Investig, 2003, 23(7): 439-450.
17. Urueta-Robledo J, Ariza H, Jardim JR, et al. Moxifloxacin versus levofloxacin against acute exacerbations of chronic bronchitis: the Latin American Cohort. Respir Med, 2006, 100(9): 1504-1511.
18. Friedman H, Song X, Crespi S, et al. Comparative analysis of length of stay, total costs, and treatment success between intravenous moxifloxacin 400 mg and levofloxacin 750 mg among hospitalized patients with community-acquired pneumonia. Value Health, 2009, 12(8): 1135-1143.

Chinese Journal of Evidence-Based Medicine

Moxifloxacin versus Levofloxacin for Acute Exacerbation of Chronic Obstructive Pulmonary Diseases: A Systematic Review

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