Challenges in the management of community-acquired pneumonia: the role of quinolones and moxifloxacin.

Current strategies and guidelines for the treatment of community-acquired pneumonia are directed toward making care cost effective, by treating patients on an outpatient basis whenever possible. The use of the new fluoroquinolones could help to achieve these goals. These agents are highly bioavailable and can facilitate the oral treatment of certain patients who otherwise might be admitted to the hospital, as outpatients. The good absorption and bioavailability of these agents can allow moderately ill patients to rapidly achieve effective serum levels of the drug after oral administration and can also facilitate early discontinuation of intravenous therapy and early discharge for responding inpatients. For inpatients or outpatients with clinical risk factors for acquiring drug-resistant pneumococci, quinolones represent a reliable monotherapy option and an effective alternative to a beta-lactam/macrolide combination. Although the in vitro differences among the various quinolones remain of unclear clinical relevance, preliminary data suggest that agents with enhanced in vitro activity against pneumococci, such as moxifloxacin, may have greater clinical efficacy and may lead to more-rapid resolution of fever and, potentially, less selection of future pneumococcal resistance to quinolones than that associated with agents with less intrinsic activity.