Efficacy of empiric macrolides versus fluoroquinolones in community-acquired pneumonia associated with atypical bacteria: A meta-analysis
Abstract
INTRODUCTION
It is unclear if one empiric regimen for community-acquired pneumonia (CAP) associated with atypical bacteria is superior to another. The objective of this meta-analysis was to compare fluoroquinolones to macrolides in the rates of clinical failure in CAP associated with atypical pathogens.
METHODS
We searched PubMed and EMBASE databases for randomized controlled trials (RCTs) comparing the clinical efficacy of fluoroquinolones with macrolides for CAP associated with atypical bacteria. We estimated risk differences (RRs) with 95% confidence intervals (CIs) using random-effects models and assessed for heterogeneity (I2).
RESULTS
Five RCTs met the inclusion criteria. No significant differences between macrolides and fluoroquinolones and were identified in rates of clinical failure in CAP associated with any atypical bacteria (RR = 1.57 [95% CI 0.73 to 3.38]; p = 0.251; I2 = 0%), Chlamydia pneumoniae (RR = 2.12 [95% CI 0.63 to 7.14]; p = 0.223; I2 = 0%), Mycoplasma pneumoniae (RR = 1.28 [95% CI 0.57 to 2.92]; p = 0.550; I2 = 0%), or Legionella pneumophila (RR = 0.24 [95% CI 0.02 to 2.86]; p = 0.256; I2 = 0%).
CONCLUSIONS
This meta-analysis of RCTs found no significant differences between macrolides and fluoroquinolones in rates of clinical failure in CAP associated with atypical bacteria.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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