Omadacycline vs. Moxifloxacin for Community-Acquired Pneumonia: A Real-World Retrospective Comparative Effectiveness and Safety Study

Background This retrospective study aimed to compare the real-world clinical effectiveness and safety of omadacycline versus moxifloxacin in treating adult patients with CAP. Methods This single-center, retrospective cohort study was conducted at the First Affiliated Hospital of Guangxi University of Science and Technology. A total of 348 adult inpatients diagnosed with CAP between June 2022 and December 2024 were enrolled and divided into an Omadacycline group (n = 170) and a Moxifloxacin group (n = 178). The primary outcome was early clinical response (ECR), assessed 72–120 hours after treatment initiation. Secondary outcomes included overall clinical response rate, bacterial eradication rate, changes in inflammatory biomarkers, and adverse events.. Results Baseline characteristics were comparable between the two groups. The ECR success rate was 92.9% (158/170) in the Omadacycline group and 91.0% (162/178) in the Moxifloxacin group (absolute risk difference: 1.9%, 95% CI: -4.1% to 7.9%; p = 0.508), demonstrating the non-inferior efficacy of omadacycline. Overall clinical response (92.9% vs. 91.0%, p = 0.508) and bacterial eradication rates (88.2% vs. 86.8%, p = 0.776) were also similar. Both groups showed significant and comparable improvements in inflammatory markers and pneumonia severity scores post-treatment. However, the overall incidence of adverse events was significantly lower in the Omadacycline group (15.3% vs. 30.3%, p < 0.001), primarily due to a lower incidence of gastrointestinal adverse reactions (5.9% vs. 20.8%, p < 0.001). Conclusion In this real-world study, omadacycline demonstrated non-inferior clinical effectiveness compared to moxifloxacin for treating CAP, with a significantly more favorable safety profile, particularly regarding gastrointestinal tolerability. These findings support omadacycline as an effective and safer alternative for CAP, especially for patients with concerns regarding fluoroquinolone-associated risks.