Choi, Sang-Ho;
Cesar, Antoni;
Snow, Timothy Arthur Chandos;
Saleem, Naveed;
Arulkumaran, Nishkantha;
Singer, Mervyn;
(2023)
Respiratory fluoroquinolone monotherapy versus β-lactam plus macrolide combination therapy for hospitalized adults with community-acquired pneumonia: A systematic review and meta-analysis of randomised controlled trials.
International Journal of Antimicrobial Agents
, 62
(3)
, Article 106905. 10.1016/j.ijantimicag.2023.106905.
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Abstract
INTRODUCTION: Guidelines recommend respiratory fluoroquinolone monotherapy or β-lactam plus macrolide combination therapy as first-line options for hospitalized adults with mild to moderate community-acquired pneumonia (CAP). Efficacy of these regimens has not been adequately evaluated. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing respiratory fluoroquinolone monotherapy and β-lactam plus macrolide combination therapy in hospitalised adults with CAP. A meta-analysis was performed using a random effects model. The primary outcome was clinical cure rate. Quality of evidence (QoE) was evaluated using GRADE methodology. RESULTS: A total of 4,140 participants in 18 RCTs were included. Levofloxacin (11 trials) or moxifloxacin (six trials) were the predominant respiratory fluoroquinolones trialled, while the β-lactam plus macrolide group used ceftriaxone plus a macrolide (ten trials), cefuroxime plus azithromycin (five trials), and amoxicillin/clavulanate plus a macrolide (two trials). Patients receiving respiratory fluoroquinolone monotherapy had a significantly higher clinical cure rate (86.5% vs. 81.5%; odds ratio [OR] 1.47 [95% CI: 1.17-1.83]; P = 0.0008; I2 = 0%; 17 RCTs; moderate QoE) and microbiological eradication rate (86.0% vs. 81.0%; OR 1.51 [95% CI: 1.00-2.26]; P = 0.05; I2 = 0%; 15 RCTs; moderate QoE). All-cause mortality (7.2% vs. 7.7%; OR 0.88 [95% CI: 0.67-1.17]; I2 = 0%; low QoE) and adverse events (24.8% vs. 28.1%; OR 0.87 [95% CI: 0.69-1.09]; I2 = 0%; low QoE] were similar between groups. CONCLUSION: Respiratory fluoroquinolone monotherapy demonstrated an advantage in clinical cure and microbiologic eradication; however, it did not impact mortality.
| Type: | Article |
|---|---|
| Title: | Respiratory fluoroquinolone monotherapy versus β-lactam plus macrolide combination therapy for hospitalized adults with community-acquired pneumonia: A systematic review and meta-analysis of randomised controlled trials |
| Location: | Netherlands |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.ijantimicag.2023.106905 |
| Publisher version: | https://doi.org/10.1016/j.ijantimicag.2023.106905 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | beta-lactam, fluoroquinolone, macrolide, meta-analysis, Pneumonia |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Experimental and Translational Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10179051 |
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