title: β-Lactam/macrolide dual therapy versus β-lactam monotherapy for the treatment of community-acquired pneumonia in adults: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Several studies have compared the clinical effect of β-lactam/macrolide (BLM) dual therapy versus β-lactam (BL) monotherapy in community-acquired pneumonia (CAP) patients. However, the results remain controversial. Thus, we did this meta-analysis to determine which treatment was more effective.
  
  
  METHODS
  Databases comprising PubMed, Embase and the Cochrane Register of Controlled Trials were searched to find relevant studies. The primary outcome was mortality. The Newcastle-Ottawa scale was used to evaluate the methodological quality of included studies. Multivariable-adjusted ORs with 95% CIs were pooled in the random effects model.
  
  
  RESULTS
  Four prospective cohort studies and 12 retrospective cohort studies were included (n = 42 942). Compared with BL monotherapy, BLM dual therapy was significantly associated with reduced mortality (adjusted OR 0.67, 95% CI 0.61-0.73, P < 0.001, I(2) = 3%). Subsequent subgroup analyses confirmed that BLM dual therapy was statistically superior to BL monotherapy in reduction of mortality. Sensitivity analyses strengthened the validity of the results.
  
  
  CONCLUSIONS
  In comparison with BL monotherapy, BLM dual therapy might reduce mortality risk in patients with CAP. Because this finding is based on observational studies, randomized controlled trials are required to demonstrate the usefulness of BLM dual therapy in the treatment of CAP.
authors.affiliation: Department of Respiratory Medicine, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Nie
authors.affiliation: Department of Respiratory Medicine, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Respiratory Medicine, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China xiu_qingyu@126.com.
authors.forename: Qingyu
authors.initials: Q
authors.lastname: Xiu
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D004359:Drug Therapy, Combination; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D016017:Odds Ratio; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D017594:Publication Bias; D016896:Treatment Outcome; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides; D047090:beta-Lactams
keywords: antibiotics; lung infections; mortality