Is β-Lactam Plus Macrolide More Effective than β-Lactam Plus Fluoroquinolone among Patients with Severe Community-Acquired Pneumonia?: a Systemic Review and Meta-Analysis.
10.3346/jkms.2017.32.1.77
- Author:
Jong Hoo LEE
1
;
Hyun Jung KIM
;
Yee Hyung KIM
Author Information
1. Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.
- Publication Type:Meta-Analysis ; Original Article
- Keywords:
Pneumonia;
Intensive Care Units;
Mortality;
Macrolides;
Fluoroquinolone
- MeSH:
Bias (Epidemiology);
Humans;
Intensive Care Units;
Length of Stay;
Macrolides;
Mortality;
Pneumonia*
- From:Journal of Korean Medical Science
2017;32(1):77-84
- CountryRepublic of Korea
- Language:English
-
Abstract:
Adding either macrolide or fluoroquinolone (FQ) to β-lactam has been recommended for patients with severe community-acquired pneumonia (CAP). However, due to the limited evidence available, there is a question as to the superiority of the two combination therapies. The MEDLINE, EMBASE, Cochrane Central Register, Scopus, and Web of Science databases were searched for systematic review and meta-analysis. A total of eight trials were analyzed. The total number of patients in the β-lactam plus macrolide (BL-M) and β-lactam plus fluoroquinolone (BL-F) groups was 2,273 and 1,600, respectively. Overall mortality of the BL-M group was lower than that of the BL-F group (19.4% vs. 26.8%), which showed statistical significance (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.49 to 0.94; P = 0.02). Length of hospital stay was reduced in the BL-M group compared to the BL-F group (mean difference, −3.05 days; 95% CI, −6.01 to −0.09; P = 0.04). However, there was no significant difference in length of intensive care unit (ICU) stay between the two groups. Among patients with severe CAP, BL-M therapy may better reduce overall mortality and length of hospital stay than BL-F therapy. However, we could not elicit strong conclusions from the available trials due to high risk of bias and methodological limitations.
