Objective: To compare the clinical efficacy of moxifloxacin and levofloxacin in the treatment of elderly patients with community-acquired pneumonia (CAP). Methods: A total of 80 elderly CAP patients admitted between April 2023 and February 2024 were randomly divided into two groups. The control group (n = 40) received treatment with levofloxacin, while the observation group (n = 40) was treated with moxifloxacin. Relevant clinical indicators were observed and compared between the two groups. Results: The overall effective treatment rate in the observation group reached 95.00%, significantly higher than the 75.00% observed in the control group (P < 0.05). The time required for improvement in clinical symptoms was significantly shorter in the observation group compared to the control group (P < 0.001). Pulmonary function indicators, including FVC, FEV1, and FEV1/FVC, improved in both groups after treatment, but the improvement was more pronounced in the observation group (P < 0.001). Serum inflammatory factor levels indicated that post-treatment levels of IL-6, PCT, and CRP decreased in both groups compared to pre-treatment levels, with a more significant reduction in the observation group (P < 0.001). The incidence of adverse reactions in the observation group was 7.50%, markedly lower than the 25.00% observed in the control group (P < 0.05). Conclusion: Moxifloxacin demonstrates better clinical efficacy and safety in the treatment of elderly patients with CAP, making it a valuable option for clinical application. However, the choice of medication should still consider individual patient conditions comprehensively.