J Korean Med Sci.  2017 Jan;32(1):77-84. 10.3346/jkms.2017.32.1.77.

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

• Lee JH
• Kim HJ
• Kim YH

• KMID: 2417588
• DOI: http://doi.org/10.3346/jkms.2017.32.1.77

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.

Keyword

Pneumonia; Intensive Care Units; Mortality; Macrolides; Fluoroquinolone

MeSH Terms

Bias (Epidemiology)
Humans
Intensive Care Units
Length of Stay
Macrolides
Mortality
Pneumonia*
Macrolides

Figure

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  Fig. 1 Flow chart of study selection.

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  Fig. 2 Pooled results of adjusted odds ratio for overall mortality among patients with severe CAP treated with BL-M vs. BL-F. CAP = community-acquired pneumonia, M–H = Mantel–Haenszel, CI = confidence interval, df = degrees of freedom, BL-M = β-lactam plus macrolide, BL-F = β-lactam plus fluoroquinolone.

• 

  Fig. 3 Pooled results of adjusted odds ratio for overall mortality among the patients with severe CAP treated with BL-M vs. BL-F. (A) Thirty-days mortality. (B) ICU mortality. CAP = community-acquired pneumonia, M–H = Mantel–Haenszel, CI = confidence interval, df = degrees of freedom, BL-M = β-lactam plus macrolide, BL-F = β-lactam plus fluoroquinolone, ICU = intensive care unit.

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  Fig. 4 Pooled results of mean difference for length of stay among critically ill patients with severe CAP treated with BL-M vs. BL-F. (A) Length of hospital stay in days.(B) Length of ICU stay in days. CAP = community-acquired pneumonia, SD = standard difference, IV = inverse variance, CI = confidence interval, df = degrees of freedom, BL-M = β-lactam plus macrolide, BL-F = β-lactam plus fluoroquinolone, ICU = intensive care unit.

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