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Is beta-Lactam Plus Macrolide More Effective than beta-Lactam Plus Fluoroquinolone among Patients with Severe Community-Acquired Pneumonia?: a Systemic Review and Meta-Analysis

Authors
Lee, Jong HooKim, Hyun JungKim, Yee Hyung
Issue Date
1월-2017
Publisher
KOREAN ACAD MEDICAL SCIENCES
Keywords
Pneumonia; Intensive Care Units; Mortality; Macrolides; Fluoroquinolone
Citation
JOURNAL OF KOREAN MEDICAL SCIENCE, v.32, no.1, pp.77 - 84
Indexed
SCIE
SCOPUS
KCI
Journal Title
JOURNAL OF KOREAN MEDICAL SCIENCE
Volume
32
Number
1
Start Page
77
End Page
84
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/85114
DOI
10.3346/jkms.2017.32.1.77
ISSN
1011-8934
Abstract
Adding either macrolide or fluoroquinolone (FQ) to beta-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 beta-lactam plus macrolide (BL-M) and beta-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.
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