Moxifloxacin versus Ampicillin / Sulbactam in the treatment of aspiration pneumonia and primary lung abscess

Objective: Aspiration pneumonia (AP) and primary lung abscess (PLA) are rare diseases, which can be associated with life-threatening complications. The main cause of these diseases is an aspiration of infectious material from the oral cavaty or stomach. There is limited information on optimal antibacterial therapeutic regimens, which schould include anaerobic bacteria. We compared clinical and bacteriologic efficacy and safety of moxifloxacin (MOX) with that of ampicillin/sulbactam (AMP/SBT) in the treatment of AP and PLA.

Methods: Prospective open-label randomized multicenter trial including patients with pulmonary infections following aspiration. Sequential antibiotic therapy with either MOX or AMP/SBT was administered until complete resolution of radiologic and clinical abnormalities.

Results: A total of 139 patients with AP and PLA was included. 96 inividuals were treated according to the protocol, with 48 patients receiving MOX and 48 patients receiving AMP/SBT. Almost 2/3 of the patients were diagnosed solely with AP (64.6%). Definite or presumptive pathogens (n=100) were isolated in 70 subjects (8.8% anaerobes; 40.2% aerobic gram positive; 51.0% aerobic gram negative). The overall clinical response rates in both treatment groups were numerically identical (66.7%). MOX and AMP/SBT were both well tolerated, even after long term administration (mean duration of treatment (in days) 26.2±29.2 (MOX) vs. 21.1±23.3 (AMP/SBT).

Conclusion: An antibiotic therapy is the treatment of choice for pulmonary infections following aspiration, if administered for a sufficient period of time. In the treatment of aspiration associated pulmonary infections moxifloxacin appears to be clinically as effective and safe as the comparator regimen (ampicillin/sulbactam), however, having the additional benefit of a more convenient (400mg qd) treatment.