OBJECTIVES: Respiratory fluoroquinolones are considered to be an important treatment option in hospitalized adults with community-acquired pneumonia (CAP). We aimed to compare cost-effectiveness of sequential intravenous to oral therapy of CAP with moxifloxacin and levofloxacin ± beta-lactam in a multi-field Russian hospital. METHODS: Standard search of prospective randomized clinical trials (RCT) was performed for the period since 1st Jan 1995 till 31st Dec 2012. RCTs quality was assessed by Jadad scale. Three RCTs with direct comparison of moxifloxacin vs. levofloxacin±ceftriaxone in adults with CAP required initial intravenous antimicrobial therapy [Torres A. 2008, File T.M. Jr. 2001, Anzueto A. 2006] were included in the analysis. As similar efficacy and safety was shown between comparators a cost-minimisation model was applied. Original drugs’ costs were extracted from hospital receipt notes of three multi-field hospitals and wholesale prices database (www.pharmindex.ru). Cost of therapy was calculated to respective treatment regiments in selected trials: moxifloxacin 400 mg QD vs. levofloxacin 500 mg QD/BID±ceftriaxone 2 g QD for 11 days. Uncertainty was explored in a series of one- and two-way sensitivity analysis. RESULTS: The respective total drug therapy costs per patient were as follows: €249 for moxifloxacin vs. €161/€321 for levofloxacin QD/BID and €419/€579 for levofloxacin QD/BID+ceftriaxone. In levofloxacin monotherapy regimens the results were sensitive for IV therapy duration and oral/IV levofloxacin cost. In both levofloxacin+ceftriaxone regimens the results were insensitive to all variables of interest. CONCLUSIONS: Moxifloxacin is more cost effective strategy then levofloxacin+ceftriaxone for the treatment of hospitalized adults with CAP. The higher cost-effectiveness for moxifloxacin vs. levofloxacin monotherapy depends on IV therapy duration, levofloxacin regimen and oral/IV levofloxacin cost.