Empiric antibiotic therapy for moderate-to-severe community-acquired pneumonia: a systematic review and network meta-analysis
Abstract
BACKGROUND: The optimal empiric antibiotic regimen for moderate-to-severe community-acquired pneumonia (CAP) is uncertain. OBJECTIVES: To compare the effects of antibiotics for empiric therapy of moderate-to-severe CAP using a network meta-analysis. DATA SOURCES: Medline, EMBASE, Cochrane CENTRAL, Web of Science, and CINAHL from inception to 03 July 2024. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCT). PARTICIPANTS: Adults with moderate-to-severe CAP. INTERVENTIONS: Any empiric antibiotic regimen vs. another, placebo, or no treatment. ASSESSMENT OF RISK OF BIAS: Paired reviewers independently assessed risk of bias using a modified Cochrane tool for assessing risk of bias in randomized trials. METHODS OF DATA SYNTHESIS: We conducted frequentist random-effect network meta-analyses addressing patient-important outcomes and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: In total, 143 RCTs involving 29,157 participants proved eligible. Effects are in comparison with respiratory fluoroquinolones alone. Penicillins alone (relative risks [RR]: 1.25, 95% CI: 0.93-1.67; risk difference [RD]: 33 more per 1000, 95% CI: 9 fewer to 88 more), second-generation cephalosporins alone (RR: 1.34, 95% CI: 0.89-2.02; RD: 45 more per 1000, 95% CI: 15 fewer to 135 more), and third-generation cephalosporins alone (RR: 1.32, 95% CI: 0.99-1.77; RD: 42 more per 1000, 95% CI: 1 fewer to 102 more) or…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 29,157 participants or records.
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