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울산의대,서울아산병원

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Int. J. Antimicrob. Agents, 2023 Jun 27;106905 | https://doi.org/10.1016/j.ijantimicag.2023.106905 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

Sang-Ho Choi ^a,b, Antoni Cesar ^a, Timothy Arthur Chandos Snow ^a, Naveed Saleem ^a, Nishkantha Arulkumaran ^a, Mervyn Singer^a

^aBloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
^bDepartment of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

Corresponding author: Sang-Ho Cho

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.

논문정보

형식Review Paper
게재일2023년 06월 (BRIC 등록일 2023-07-14)
연구진국내(교신)+국외 연구진
분야 의약학 > 응용의학

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