Bronchoscopy in the Czech Republic in the past 45 years and the state in 2020.

BACKGROUND AND METHOD: To determine the current situation and trends in bronchology in the Czech Republic (CR), a questionnaire survey has been conducted by the Czech Pneumological and Phthisiological Society (CPFS). RESULTS: In 2020, 158 bronchoscopists conducted 26,700 BRS procedures, 927 of them were rigid. 2,869 procedures were done under general anaesthesia. Of diagnostic methods, the use of endobronchial ultrasound (EBUS) is rising, being available in 35 % BRS facilities in 2020. Interventional bronchology procedures are conducted in 17 facilities and 1,517 were executed in 2020. The numbers of cryocauterizations and stenting are growing. In the questionnaire we asked also about biomarkers of lung carcinoma that are examined at 47 out of 49 facilities. Since 1975 when 11,194 bronchoscopies were conducted in the CR, their numbers increased to 33,282 in 2009, then dropping slightly to 26,700 in 2020. At present, 254 bronchoscopies are conducted per 100,000 inhabitants in a year. CONCLUSIONS: Based on the BRS survey in 2020 it can be concluded that Czech bronchology is developing in the right direction and is well equipped with both, staff and technical devices. We are adopting new methods without delays and we expand the use of those working well (EBUS) (Tab. 4, Ref. 13).

Cyprinid herpesvirus-3 (CyHV-3) disturbs osmotic balance in carp (Cyprinus carpio L.)--A potential cause of mortality.

Cyprinid herpesvirus-3 (CyHV-3) causes a fatal disease in carp (Cyprinus carpio) and its ornamental koi varieties which seriously affects production and trade of this fish species globally. Up to now, the pathophysiology of this disease remains unclear. Affected individuals develop most prominent lesions in gills, skin and kidney, in tissues which are involved in the osmotic regulation of freshwater teleosts. Therefore, here serum and urine electrolyte levels were examined during the course of an experimental infection of carp with CyHV-3. In infected carp an interstitial nephritis with a progressive deterioration of nephric tubules developed, which was paralleled by elevated electrolyte losses, mainly Na(+) in the urine. The urine/plasma ratio for Na(+) increased from 0.03 in uninfected carp to 0.43-0.83 in carp under CyHV-3 infection, while concentration of divalent ions were not significantly changed. These electrolyte losses could not be compensated since plasma osmolality and Na(+) concentration dropped significantly in CyHV-3 infected carp. This was most probably caused by the progressive deterioration of the branchial epithelium, which in teleosts plays a prominent role in osmoregulation, and which was seen concomitantly with decreasing electrolyte levels in the serum of carp under CyHV-3 infection. Immediately after infection with CyHV-3, by day 2 post exposure, affected carp showed severe anaemia and prominent leucocytosis indicating the development of an acute inflammation, which could intensify the observed hydro-mineral imbalances. The data presented here show that an infection with CyHV-3 induces an acute inflammation and a severe dysfunction of osmoregulation in affected carp or koi, which may lead to death in particular in the case of acute disease progression.

Changes in skin mucus of common carp, Cyprinus carpio L., after exposure to water with a high bacterial load.

Water in aquaculture systems may contain a high load of microorganisms. Reduction in overall bacterial tank water load improves fish health and growth parameters. In this study, the effect of an increase of overall bacterial load in tank water on carp skin mucus was assessed. Intracellular and released high molecular weight glycoproteins (HMGs) of carp skin mucus were analysed for changes using histological, histochemical and biochemical techniques. Increase of bacterial load did not induce obvious clinical responses in carp, but the skin of exposed carp responded quickly. The amount of skin mucus HMGs isolated increased as well as their total glycosylation. An increased goblet cell number was observed for all carbohydrate stainings, but most clearly for acidic glycoconjugates. A change in the terminal presence of some sugars was also seen. After the initial response of carp, an adaptation to the higher bacterial load in the water appeared to occur as mucins had a higher glycosylation. The changes observed suggest that these skin mucus adaptations are part of a primary defence mechanism of mucosal epithelia, even at a low pathogenic pressure.

[Analysis of symptoms and case history data in the set of 353 patients with lung cancer]. / Analýza anamnestických dat a výsledku vysetrení v souboru 353 nemocných s plicním karcinomem z let 2004-2007.

BACKGROUND: Lung cancer (LC) incidence in men in the Czech Republic has been declining since 1995, in women it grows up continually. To analyse the characteristics of recent set of patients (pts) and contribution of their symptoms for diagnostic, treatment and prognosis we carried on the retrospective study on patients from 1st Pulmonary department from 2004-2007. METHODS AND RESULTS: Men:women ratio in the set of 353 pts was 2:1. The frequency of symptoms at the time of diagnosis were: cough 69%, dyspnoe 54%, loss of weight 49%, expectoration 39%, pain on the chest 37%, haemoptysis 17.7%, fever 16%, vena cava superior syndrome 3.7%. Smokers fell in to the disease in significantly younger age than nonsmokers, 63 vs. 73 years. 40% of pts with LC suffer from COPD, more frequently have had squamous type of cancer. 78% of the set was morphologically verified, most frequent types of cancer were squamous type (22.1%) followed by adenocarcinoma, 21.2%. Surgical therapy underwent 18.1% of the whole set. We look consequently for correlation between symptoms and other data of the pts. The pts with abuse of alcohol beverage fell in to the disease in a younger age. The pts with central tumor suffer from stronger cough more frequently, at bronchoscopy had more often direct tumor changes. The pts with IV. TNM stage of LC more frequently suffer from fever and pain. Significantly fewer pts with dyspnoe, loss of weight and lower FEV1 underwent surgical resection, FEV1 was lower in pts with central than with peripheral type of tumor. In pts with direct bronchoscopical tumor changes were found more frequently haemoptysis, broader spectrum of symptoms, lower FVC and FEV1. Dyspnoe correlated with PaO2 but not with PaCO2. CRP was lower in pts with peripheral type of LC, higher in pts with small cell LC (SCLC). Occurrence of haemoptysis did not correlate with number of smoked cigarettes. Conclusions. In conclusion we proofed that proper taking of history case may accelerate and improve the diagnostic process.

Influence of carp intestinal mucus molecular size and glycosylation on bacterial adhesion.

The first step of the pathogenesis of many infectious diseases is the colonisation of the mucosal surface by the pathogen. Bacterial colonisation of the mucosal surface is promoted by adherence to high molecular weight mucus glycoproteins. We examined the effect of carp intestinal mucus glycoproteins on the adhesion of different bacteria. The bacteria used were 3 strains of Aeromonas hydrophila, and A. salmonicida, Edwardsiella tarda and Yersinia ruckeri. All bacteria adhered to mucus, but at varying intensities. All tested bacteria adhered best to molecules of 670 to 2000 kDa in size, less to molecules larger than 2000 kDa and weakest to molecules of 30 to 670 kDa. In general, bacteria that showed a stronger adhesion to intestinal mucus were cytotoxic to cells in vitro, and bacteria that showed a weaker adhesion to intestinal mucus did not lead to alterations of monolayers of EPC-cells. Furthermore, the involvement of glycan side chains of the glycoproteins for bacterial adhesion was analysed for one A. hydrophila strain. After cleavage of terminal sugar residues by treatment of mucus glycoproteins with different glycosidases, binding of bacteria was modulated. When mannose was cleaved off, adhesion significantly increased. Blocking of glycan receptors by incubation of bacteria with different oligosaccharides had no clear effect on bacterial binding to mucus glycoproteins. Our results suggest that bacteria interact with carbohydrate side chains of mucus glycoproteins, and that the carbohydrates of the core region are involved in bacterial binding.

Chemotaxis towards, adhesion to, and growth in carp gut mucus of two Aeromonas hydrophila strains with different pathogenicity for common carp, Cyprinus carpio L.

Characteristics that promote bacterial colonization of the intestinal mucosal surface were examined in two strains of the common fish pathogen Aeromonas hydrophila, with different pathogenicity. The characteristics examined were chemotactic activity towards mucus, bacterial adherence to mucus and growth in mucus. Intestinal gut mucus of healthy common carp was used. The results indicate that chemotaxis is not necessary for a bacterium to become pathogenic, but it may be a necessary parameter for a bacterium to be an obligate pathogen. Adhesion also seems to be a factor influencing pathogenicity. The results suggest that higher adhesion to mucus and subsequent growth is associated with differences in pathogenicity.

[Incidence, diagnostics and therapy of the lung cancer in the Czech Republic in 2003]. / Výskyt, diagnostika a léca plicího karcinomu v Ceské republice v roce 2003.

Lung cancer epidemic has not ended. According to the data on the incidence and mortality in the Czech Republic it is obvious that both parameters decline in males; the rise in women probably ends. According to the present epidemiological parameters the number of new cases is still very high. Number of adenocarcinomas is slightly rising. No improvement has been achieved in the early diagnostics of TNM stage I and II, which are diagnosed in less than 21 %. It brings low number of indications for resection therapy, which in 2003 achieved 10.8 % for men and 10.1 % for women. Positive appears the higher number of verified tumours (72 % in men and 69 % in women) and the higher percentage of those who survived over 5 years (6.3 % in men and 9.4 % in women) in comparison with the situation 10 years earlier. The presented paper describes regional differences in the incidence of lung carcinoma (apparent gradient between the western and eastern part of the country) and the promptness of the diagnostics and the treatment indications.

[Treatment of lung carcinoma patients at the First Department of Tuberculosis and Respiratory Diseases]. / Péce o nemocné s plicním karcinomem na I. klinice tuberkulózy a respiracních nemocí.

Lung carcinoma (BCA) represents the most frequent malignancy in men and the fourth most frequent one in women. In 2004, 5568 persons died from that disease. Study of the lung carcinoma has been the main research program of the First Department of Tuberculosis and Respiratory Diseases of the First Faculty of Medicine, Charles University and General Teaching Hospital since 1960. The presented article summarises results from present and older studies which can show that numbers of diagnosed BCA patients increased since 1960 till 1977, when they reached 96 cases. Since that time the situation has been stabile and the present number of newly diagnosed cases is about 90 cases. Ratio of men and women has changed--since the cohort in 1960 to 1961 with ratio 8:1, to the present ratio 2:1. Number of cases diagnosed at the first and second stadium decreased from 56% at the beginning of our study in 1960 to 1961 to 19.9% in the cohort from 2004 to 2006. Occurrence of individual structural types of carcinomas has also changed; the second position after the epidermoid types has now adenocarcinoma. Number of microscopically verified BCA cases increased from 32% at the beginning to 79% at present. Proportion of treatment methods has also changed. Surgical treatment increased from 10.1% in 1960-1961 to 16.7% in 1985-1987 and remained stabile since that. Radiotherapy was used in 10% of cases in 1960 to 1961 and in 39.5% in 2004 to 2006. Number of patients with chemotherapy increased from 41% to 58% during the same period. In 2004 to 2006 bronchoscopy verified 95% of cases with direct tumor changes, 54% of indirect changes and in 20% bronchoscopy revealed normal picture. Our results show that the treatment approaches for patients with BCA has developed with the constant necessity to improve the assessment, diagnostics and therapy of new cases.

[Diagnostics and indications of surgical treatment of patients with lung carcinoma at the first clinic of TRN of the first faculty of medicine and the VFN Prague in years 2004 to 2005]. / Diagnostika a indikace operacni lécby nemocných s plicním karcinomem na I. klinice TRN 1. LF UK a VFN praha v letech 2004-2005.

BACKGROUND: Results of the diagnostics and indications of surgical treatment of patients with lung carcinoma (BCA) at the First clinic in years 2004 to 2005 were evaluated in a retrospective study. METHODS AND RESULTS: The cohort of 209 patients with the male to female ratio of 2 to 1 included 63 % of current smokers, 22 % of former smokers and 15 % of non-smokers. BCA was diagnosed in significantly earlier age in smokers in comparison to former smokers or non-smokers. Men had smoked in average 107 000 of cigarettes more than women. In the family history we found one or more malignancies in 49 % of patients. In the personal history COPD was found in 42 % of patients. Patients with COPD had more frequently epidermoid type of cancer. In patients diagnosed at earlier stages of BCA (I to IIIA) COPD was present more frequently as an intercurrent disease in comparison with patients in higher stages. 34 % of patients had a history of alcohol abuse, the median age of alcoholic patients was 65 years, the median age of other patients was 70 years. In histologically verified tumours, the highest occurrence had the epidermoid type (29% of patients) and adenocarcinoma (27 %). 39 patients (18.6 % from the cohort) were surgically treated; from 128 patients with NSCLC 33 were surgically treated (25 % of NSCLC cohort). Among the causes of surgical treatment impossibility, the most frequent ones were COPD in the third to four stage, age over 80 years, polymorbidity and ill-being. CONCLUSIONS: Results of our study indicate that BCA is frequently diagnosed in already developed stage, numbers of surgically treated patients represent less than 20% of the total patients' number.

[Lung cancer operability--history and presence]. / Operabilita bronchogenního karcinomu--historie a soucasnost.

Review of contemporary publication on the operability of lung cancer in the Czech Republic and in other countries is presented. Since 1912, when 374 cases of lung cancer were described, the incidence has risen and culminated towards the end of the 20th century. From the available treatment modalities, surgery gives the best results. An overview of papers describing the beginning of thoracic surgery in the Monde and in the Czech Republic is given. In the Czech Republic during 2002, 11.3% of all lung cancers were resected. From the TRN clinics in the Czech Republic about 20 to 27% of patients are recommended. In the leading world centres the operability is higher--about 25 to 35% of patients. The improvement of operability of lung cancer is possible namely by the increase of timely diagnosed tumors and by more frequent use of neoadjuvant medication in the treatment algorithms.

[Treatment of benign stenoses of the large airways at the Faculty Hospital Praha-Motol during 1998-2003]. / Lécba benigních stenóz velkých dýchacích cest ve Fakultní nemocnici Praha-Motol v letech 1998-2003.

The authors present diagnostic and therapeutical results in the group of 80 patients with benign stenoses of large airways, who were hospitalized at the TRN ward (Department of TB and respiratory disorders) of the Faculty hospital Motol in Prague between the years 1998-2003. 62 patients sufferred from stenoses in cosequence of their tracheal intubation or tracheostomy. In 18 cases the stenoses resulted from other disorders or pathological condidtions (Wegener's granulomatosis, status post lung transplantation, etc.) 38 patients were sent for surgery. Up until the date of the assessment (September 2003), 8 of them had had a relaps of the condiditon. 6 operated subjects had their restenosis corected using bronchological methods, 2 subjects had to undergo reoperation, which is 5.2% of the total number of the operated subjects. The remaining 42 patients were treated using the interventional bronchological methods (electrocauther, laser, stents) which proved curative in 35 patients, i.e 44% of the whole group. In 7 inoperable patients the above methods failed, 6 of them having a permanent tracheostomy and one female-patient exited 2 days after an incomplete recanalization. In the subgroup of 18 patients with other than postintubation stenoses, stent operations were the most frequent (12 times), 4 patients were cured using other methods of interventional bronchology, and resection of the stenosis was indicated in two cases. Up until the date of the assessment, 65 subjects had survived and 15 exited. 5 of them died 3-14 months (median of 4 months) following the surgical procedure of other disorders than of the respiratory airways stenoses. 10 unoperated patients, with a single exception, also died due to other causes than the tracheobroncheal lesions (the survival rate median was 9 months). Following the initial freeing of the airways, the authors call for considering a surgical therapeutical option in each case. Provided the surgical approach was contraindicated, the interventional bronchological methods would replace it appropriately.

[Results of treatment of malignant stenoses of the respiratory tract in a long term study]. / Výsledky lécby maligních stenóz dýchacích cest v dlouhodobém sledování.

BACKGROUND: :The malignant stenoses complicate the course of the disease in about 50% of patients with lung tumors. Management of them can influence the quality of life of the afflicted. There is no general agreement about optimal methods of their therapy, of selection of the best methods and also there is only few data about survival of these patients. METHODS AND RESULTS: 130 patients with tumors stenoses of the airways were prospectively followed in the 1998-2003 period, 93 of them suffered from lung cancer. Besides other treatment of the tumor they underwent also interventional bronchoscopy (Nd YAG laser, electrocautery i.e.). The airways were opened completely in 62% of the set of patients. The interventional bronchoscopy was complicated in 9% of patients, 32 patients lived at the 31st December of 2003, 98 of them had died. One year survival was 23.1%, median survival of the whole set of patients was 7 months. The patients with lung cancer had significantly worse survival than patients with other types of lung tumors, 6 months versus 10 months. There were no significant survival differences of the whole set according to the achieved grade of recanalisation, or according the inclusion of the brachytherapy to the set of interventional methods. The patients with inserted stent had significantly worse prognosis than the those without stenting. To homogenize the study group, the subset of patients with epidermoid lung cancer in the stage IIIB were selected (n = 51). Significantly longer survival of patients with complete recanalisation, insignificant longer survival in patients who underwent also brachytherapy and significantly shorter survival in patients with stenting were proved in this subgroup of patients. CONCLUSIONS: The interventional bronchoscopy has a low rate of complications and in most cases it has a palliative effect. The survival of patients is more influenced by the extension and the type of the tumor, their general status, polymorbidity, age etc. than by effect or selection of interventional bronchoscopical methods.

[Surgical treatment of bronchogenic carcinoma 1970-2001]. / Operacní lécba bronchogenního karcinomu v letech 1970-2001.

BACKGROUND: Lung cancer (LC) is a permanent medical and social problem. 5709 patients died in the year 2000 of this disease in Czech Republic. Its incidence in men is 100/100,000 and it shows only small trend to decrease. In women the incidence has reached 22/100,000 and is still rising. The ratio males/females in the whole country is 4:1, in pulmonary department of University hospital Motol is close to 2:1. The optimal way of treatment is a surgery. METHODS AND RESULTS: From the data about diagnostics and operability in Pneumological Clinic of the 1st Medical Faculty of the Charles University (former 2nd Clinic of Tuberculosis and Respiratory Diseases) and from adequate data obtained from the Pulmonary department of University hospital Motol we can see that the number of operated patients increased from 20% in 1970 to 28% in 2001. When compared two set of patients operated in the period 1985-1990 and 1998-2001 we learned the change of the ratio males/females (from 17:1 to 2:1), lower number of pneumonectomies (from 34% to 31%), lower number of exploratory thoracotomies (from 13% to 5%), decrease of perioperative mortality from 10% do 2%. The percentage of correct clinical when compared to pathological TNM staging was similar in both periods (55% in the period 1985-1990 and 53% in the period 1998-2001). In the article we describe also results of diagnostics, induction and adjuvant treatment and possibilities of the increase of operability of the patients with lung cancer. CONCLUSIONS: The authors think that despite some improvements in several parameters, the 5-year survival of patients with lung cancer is in our country and the whole world still unsatisfactory. We recommend the revision of current attitude to the screening of lung cancer and we recommend joining the running European-American trials of screening of such patients with the help of low-dose spiral CT.

[Benign stenoses of the large respiratory airways]. / Benigní stenózy velkých dechových cest.

BACKGROUND: Benign stenoses of main respiratory pathways develop usually in patients after intubation or tracheostomy. Incidence of such states is not known, they are frequently diagnosed too late, and there are different views of their treatment. In order to contribute to the improvement of our knowledge of this serious impairment we followed prospectively all patients with this diagnose at our department since March 1998. METHODS AND RESULTS: The group of 31 patients with benign stenoses of non-tumorous origin diagnosed and treated at the TRN of the Teaching Hospital Motol in years 1998 to 2000 consisted of 24 males and 7 females, age median was 52 years. Stenosis was caused in 27 patients by intubation, in 4 patients by some other causes. At admission we performed in 30 patients electrocauterization and dilatation of stenosis, one patient was immediately indicated for surgery. Beside two cases we always achieved sufficient patency of stenosis and weighted indication to surgery. We sent for surgery 15 patients, 10 patients were permanently healed using methods of interventional bronchoscopy, including introduction of stent in 6 cases. From the remaining 6 patients, two of them are planned for resection of stenosis, four are inoperable from various reasons, and two died of causes not related to stenosis. CONCLUSIONS: Based on our experience we recommend as an optimal management of such patients is the dilatation or removal of stenosis and then always to consider resection of trachea. In inoperable cases methods of interventional bronchoscopy should be used. Authors recommend sending all patients intubated longer than 2 days for bronchoscopic examination in interval of 2 months.

[Chronic obstructive pulmonary disease at the turn of the millennium]. / Chronická obstrukcní plicní nemoc na prelomu tisíciletí.

The article reviews information on the chronic obstructive pulmonary disease (COPD), from the domestic and international sources. Significance of the disease has recently increased, in the US it becomes the fourth most frequent cause of death. Pathogenesis of the disease is different from the bronchial asthma, though in about 10% of patients both diseases can occur simultaneously. The article brings basic pathological and pathophysiological differences between both types of disease and it describes results of functional tests in relation to the most common international standards of the diagnostics and treatment of COPD. The most recent definition of COPD, elaborated by specialists associated in the Global initiative for COPD (= GOLD), stresses the abnormal reaction to the chronic inhalation of particles. Reviewed are also mechanisms of the effect of modern bronchodilatators--long acting beta 2-agonists, permanently conflicting views on the use of corticosteroids, and on the surgical treatment of COPD. Promising method appears the treatment with long-lasting anticholinergic drugs or the attempt to affect mediator antagonist be e.g. leucotrien D4 (LTD4) and the use inhibitors of phosphodiesterase 4.

[Early diagnosis of lung carcinoma]. / Moznosti vcasné diagnostiky plicního karcinomu.

Importance of the lung cancer (LC) in our country and in the world as well as possibilities of its active screening are described. In US the lung carcinoma represents the most frequent lethal cancer both in males and females. In the Czech Republic (CR), mortality due to LC has the first place among men and the third place among women. Incidence of LC in males has not increased and for several years it has been reaching about 100 per 100,000. In women during the last 30 years mortality has increased three times reaching frequency 22 per 100,000. In the year 2000, 5709 persons died for the disease. In CR, about 6 to 7% of patients can be expected to survive 5 years, in the western Europe it is about 8%, in US 13%. Results of the diagnostics and treatment of the lung cancer revealed question on the active screening. Among the methods available at present, the most promising for conditions in CR appears the use of the low-dose spiral CT scan in the risk population. The paper brings results of a study evaluating the possibilities of the recognition of asymptomatic stadia of LC and discusses ideas of a future international study assessing the effectiveness of LC screening using this method.

[Occlusion of a post-pneumonectomy bronchopleural fistula using the Dumon stent]. / Okluze bronchopleurální pístele po pneumonektomii s vyuzitím DUMON stentu.

A postoperative bronchiopleural fistula associated with empyema of the chest is a serious complication in thoracic surgery, in particular when it develops after pneumonectomy. Some patients are in a condition which threatens their life and rules out extensive surgical interventions. Immediate thoracic drainage, thoracoscopic revision and sanation of the empyema cavity and endoscopic closure of the fistula are in indicated cases a therapeutic alternative of open surgical procedures. The justification of these miniinvasive procedures is confirmed by the submitted case-record of a successfully cured fistula associated with empyema of the chest after pneumonectomy. At the same time, based on assembled experience, the authors draw attention to the possible use of a stent.

Oral moxifloxacin vs high-dosage amoxicillin in the treatment of mild-to-moderate, community-acquired, suspected pneumococcal pneumonia in adults.

STUDY OBJECTIVES: Comparison of the efficacy and safety of moxifloxacin vs amoxicillin for treatment of mild-to-moderate, suspected pneumococcal community-acquired pneumonia (CAP) in adult patients. DESIGN: Multinational, multicenter, double-blind, randomized study. SETTING: Eighty-two centers in 20 countries (Argentina, Brazil, Chile, Croatia, Czech Republic, Estonia, France, Hong Kong, Hungary, Lithuania, Mexico, Portugal, Russia, Slovenia, South Africa, Spain, Turkey, Ukraine, United Kingdom, and Uruguay). PATIENTS: Four hundred eleven adults (inpatients or outpatients) with suspected pneumococcal CAP. INTERVENTIONS: Randomization 1:1 to moxifloxacin, 400 mg/d, or amoxicillin, 1,000 g tid, for 10 days. RESULTS: Primary efficacy parameter was clinical response, 3 to 5 days after therapy (end of therapy [EOT]) in the per protocol (PP) population (362 patients). The clinical success rate in the PP population was 91.5% (moxifloxacin) and 89.7% (amoxicillin; two-sided 95% confidence interval, -4.2 to 7.8%). The clinical cure rate in patients with proven pneumococcal pneumonia was similar in both treatment groups (87.8%). The bacteriologic success rate in 136 bacteriologically evaluable patients at the EOT was 89.7% (moxifloxacin) and 82.4% (amoxicillin). The bacteriologic success rate against Streptococcus pneumoniae was 89.6% (moxifloxacin) and 84.8% (amoxicillin). The frequency of adverse events was comparable in both treatment groups. Digestive symptoms were the most common drug-related adverse events in both treatment groups. CONCLUSIONS: Moxifloxacin was statistically at least as effective as high-dose amoxicillin for treatment of mild-to-moderate, suspected pneumococcal CAP. Moxifloxacin may be an alternative for empiric CAP treatment, especially in areas where multidrug resistance in S pneumoniae is sufficiently prevalent to preclude routine penicillin.