title: Granulocyte-Colony Stimulating Factor (G-CSF) as an adjunct to antibiotics in the treatment of pneumonia in adults.
abstract: BACKGROUND
  Granulocyte colony stimulating factor (G-CSF) is a naturally-occurring cytokine that has been shown to increase neutrophil function and number. Exogenous administration of recombinant G-CSF (filgrastim, pegfilgrastim or lenograstim) has found extensive use in the treatment of febrile neutropaenia, but its role in the treatment of infection in non-neutropaenic hosts is less well defined.
  
  
  OBJECTIVE
  We explored the role of G-CSF as an adjunct to antibiotics in the treatment of pneumonia in non-neutropaenic adults.
  
  
  METHODS
  We searched the following electronic databases in 2003 and updated the search in 2004: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1, 2004); MEDLINE (January 1966 to March Week 1, 2004); EMBASE (1998 to December 2003); online databases of clinical trials; and reference lists of articles. We also contacted study authors, manufacturers and distributors of G-CSF.
  
  
  METHODS
  We considered randomised controlled trials (RCTs) which included hospitalised adult patients with either community acquired pneumonia or hospital-acquired pneumonia.
  
  
  METHODS
  Two reviewers independently extracted data and assessed trial quality. The primary outcome measure was 28 day mortality. Secondary outcome measures included other markers of mortality as well as markers of adverse events, including organ dysfunction. An assessment of methodological quality was made for each study.
  
  
  RESULTS
  Six studies with a total of 1984 people were identified. G-CSF use appeared to be safe with no increase in the incidence of total serious adverse events (pooled odds ratio (OR) 0.91; 95% confidence interval (CI): 0.73 to 1.14) or organ dysfunction. However, the use of G-CSF was not associated with improved 28 day mortality (pooled OR 0.86; 95% CI: 0.56 to 1.31).
  
  
  CONCLUSIONS
  There is no current evidence supporting the routine use of G-CSF in the treatment of pneumonia. Studies in which G-CSF is administered prophylactically or earlier in therapy may be of interest.
authors.affiliation: Infectious Diseases Unit, Menzies School of Health Research, Charles Darwin University and Northern Territory Clinical School, Flinders University, PO Box 41096, Casuarina, Northern Territory, Australia, 0811.
authors.forename: A C
authors.initials: AC
authors.lastname: Cheng
authors.forename: D P
authors.initials: DP
authors.lastname: Stephens
authors.forename: B J
authors.initials: BJ
authors.lastname: Currie
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor