Fluoroquinolone treatment of community-acquired pneumonia: a meta-analysis.
OBJECTIVE
To determine the role of newer fluoroquinolones (FQs) for adults with community-acquired pneumonia (CAP) whose level of illness allows treatment with an oral antibiotic.


METHODS
Meta-analysis of randomized controlled trials comparing a macrolide, beta-lactam, or doxycycline antibiotic with a newer oral FQ for the treatment of CAP.


RESULTS
Patients (5118), most of whom were <60 years of age and free of coexisting diseases, were enrolled in 13 studies comparing an oral macrolide or beta-lactam antibiotic with an FQ for the treatment of CAP. No previous study compared doxycycline with an FQ. In the intention-to-treat (ITT) population, no trial demonstrated significant differences between FQs or alternative therapies. Summary estimates showed a statistically significant advantage in favor of the FQs in both the ITT (OR 1.22; 95% CI 1.02 to 1.47; p = 0.03) and evaluable populations (OR 1.37; 95% CI 1.11 to 1.68; p = 0.003). The number needed to treat for an FQ advantage was 33 (95% CI 17 to 362) in the ITT population and 37 (95% CI 22 to 121) in the evaluable population. Treatment failures represented slow symptom resolution; no deaths were reported.


CONCLUSIONS
The newer oral FQs showed modest therapeutic benefit compared with the studied alternative antibiotics in adults with CAP. Based on the number needed to treat from the ITT population as a measure of treatment effect, clinicians must decide whether treating 33 patients with an FQ to prevent a single therapeutic failure with another studied antibiotic warrants use of an agent from that class for an illness with a generally favorable outcome regardless of antibiotic selection, and at a time when FQ resistance may be increasing.
Salkind
Alan R
AR
Department of Medicine, Section of Infectious Diseases, School of Medicine, University of Missouri-Kansas City, 64108, USA. salkinda@umkc.edu
Cuddy
Paul G
PG
Foxworth
John W
JW
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D024841:Fluoroquinolones; D006801:Humans; D007769:Lactams; D018942:Macrolides; D011014:Pneumonia / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D007769:Lactams; D018942:Macrolides