Levofloxacin versus Moxifloxacin

Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch

Difference between Levofloxacin and Moxifloxacin

	Levofloxacin	Moxifloxacin
Drug class	Fluoroquinolone antibiotic
Indications	Broader range of FDA-approved indications, including Hospital-acquired pneumonia, Urinary tract infections
Treatment regimen		Once-daily schedule and short treatment duration provide better patient compliance
Half-life	6-8 hours	12 hours
Bioavailability	100%	90%
Spectrum of activity:	Levofloxacin has superior activity against Acinetobacter baumannii 7	Moxifloxacin has superior activity against Staphylococcus aureus 6, S. epidermidis 1, S. pneumoniae
Side effects, safety		Less phototoxic 5.

Levofloxacin vs Moxifloxacin for Pneumonia

The retrospective study found that that among patients hospitalized with community-acquired pneumonia, initial treatment with intravenous levofloxacin is associated with a significantly shorter length of stay in hospital compared with intravenous moxifloxacin 8.

Another study demonstrated that moxifloxacin therapy in the treatment of community-acquired pneumonia (CAP) produces faster clinical recovery than levofloxacin therapy, with a comparable safety profile 2.

Results of double-blind, randomized, controlled trial of moxifloxacin versus levofloxacin for the treatment of CAP in hospitalized elderly patients2	Levofloxacin	Moxifloxacin
Regimen	500 mg daily for 7-14 days	400 mg daily for 7-14 days
Number of patients in the group	140	141
Cure rates at test-of-cure	87.9%	92.9%
Clinical recovery by days 3-5 after the start of treatment	90%	97.9%
Cure rates were for patients with mild or moderate CAP	88.6%	92.6%
Cure rates for patients with severe CAP	84.6%	94.7%
Adverse events	no statistically significant differences

Levofloxacin vs Moxifloxacin for Rhinosinusitis

The once-daily administration schedule and short treatment duration of moxifloxacin may have compliance advantages over existing therapies.

Moxifloxacin treatment of acute bacterial rhinosinusitis allows for a shorter treatment course and has been associated with lower risk of treatment failure and recurrence compared to levofloxacin 3.

Levofloxacin vs Moxifloxacin for Acute Exacerbations of Chronic Bronchitis

Moxifloxacin and levofloxacin are similarly effective for acute exacerbations of chronic bronchitis (AECB) 4. Shorter treatment duration with moxifloxacin is more convenient.

Results of randomized, double blind, parallel-group clinical trial of moxifloxacin versus levofloxacin against AECB 4.	Levofloxacin	Moxifloxacin
Regimen	500 mg once daily for 7 days	400 mg once daily for 5 days
Clinical success, number of patients	203 out of 216 patients (94.0%)	201 out of 221 patients (91.0%)
Bacteriologic eradication or presumed eradication	93.8%	92.8%

Levofloxacin vs Moxifloxacin for Tuberculosis

Levofloxacin and moxifloxacin have equivalent efficacy for the treatment of multidrug-resistant tuberculosis 9, 10.

Results of comparison of levofloxacin versus moxifloxacin for multidrug-resistant tuberculosis 9.	Levofloxacin	Moxifloxacin
Regimen	750 mg/day for 3 months, 90 patients	400 mg/day for 3 months, 92 patients
Conversion to negative sputum cultures	68 (88.3%) of the 77 patients	67 (90.5%) of the 74 patients
Adverse drug reactions	6 patients (7.7%)	4 patients (5.2%)

References

1. Lemmen SW, Häfner H, Klik S, Lütticken R, Zolldann D. Comparison of the bactericidal activity of moxifloxacin and levofloxacin against Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Klebsiella pneumoniae. Chemotherapy. 2003 May;49(1-2):33-5. PubMed
2. Anzueto A, Niederman MS, Pearle J, Restrepo MI, Heyder A, Choudhri SH; Community-Acquired Pneumonia Recovery in the Elderly Study Group. Community-Acquired Pneumonia Recovery in the Elderly (CAPRIE): efficacy and safety of moxifloxacin therapy versus that of levofloxacin therapy. Clin Infect Dis. 2006 Jan 1;42(1):73-81. PubMed
3. Keating KN, Friedman HS, Perfetto EM. Moxifloxacin versus levofloxacin for treatment of acute rhinosinusitis: a retrospective database analysis of treatment duration, outcomes, and charges. Curr Med Res Opin. 2006 Feb;22(2):327-33. PubMed
4. Urueta-Robledo J, Ariza H, Jardim JR, Caballero A, García-Calderón A, Amábile-Cuevas CF, Hernández-Oliva G, Vivar-Orozco R; MOX-CB Study Group. Moxifloxacin versus levofloxacin against acute exacerbations of chronic bronchitis: the Latin American Cohort. Respir Med. 2006 Sep;100(9):1504-11. PubMed
5. Viola G, Facciolo L, Canton M, Vedaldi D, Dall'Acqua F, Aloisi GG, Amelia M, Barbafina A, Elisei F, Latterini L. Photophysical and phototoxic properties of the antibacterial fluoroquinolones levofloxacin and moxifloxacin. Chem Biodivers. 2004 May;1(5):782-801. PubMed
6. Metzler K, Hansen GM, Hedlin P, Harding E, Drlica K, Blondeau JM. Comparison of minimal inhibitory and mutant prevention drug concentrations of 4 fluoroquinolones against clinical isolates of methicillin-susceptible and -resistant Staphylococcus aureus. Int J Antimicrob Agents. 2004 Aug;24(2):161-7.
7. Heinemann B, Wisplinghoff H, Edmond M, Seifert H. Antimicrob Agents Chemother. 2000 Aug;44(8):2211-3.
8. Schein J, Janagap-Benson C, Grant R, Sikirica V, Doshi D, Olson W. A comparison of levofloxacin and moxifloxacin use in hospitalized community-acquired pneumonia (CAP) patients in the US: focus on length of stay. Curr Med Res Opin. 2008 Mar;24(3):895-906. PubMed
9. Koh WJ, Lee SH, Kang YA, et al. Comparison of levofloxacin versus moxifloxacin for multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2013 Oct 1;188(7):858-64. PubMed
10. Lee J, Lee CH, Kim DK, et al. Retrospective comparison of levofloxacin and moxifloxacin on multidrug-resistant tuberculosis treatment outcomes. Korean J Intern Med. 2011 Jun;26(2):153-9. PubMed

Published: July 20, 2014
Last updated: February 21, 2017