title: Is β-Lactam Plus Macrolide More Effective than β-Lactam Plus Fluoroquinolone among Patients with Severe Community-Acquired Pneumonia?: a Systemic Review and Meta-Analysis.
abstract: Adding either macrolide or fluoroquinolone (FQ) to β-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 β-lactam plus macrolide (BL-M) and β-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.
authors.affiliation: Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.
authors.forename: Jong Hoo
authors.identifier: http://orcid.org/0000-0003-2626-7099
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Institute for Evidence-based Medicine, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyun Jung
authors.identifier: http://orcid.org/0000-0003-2018-2385
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea. yhkim2007@hotmail.co.kr.
authors.forename: Yee Hyung
authors.identifier: http://orcid.org/0000-0002-2921-0314
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D018942:Macrolides / Q000627:therapeutic use*; D016017:Odds Ratio; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D018942:Macrolides; D047090:beta-Lactams
keywords: Fluoroquinolone; Intensive Care Units; Macrolides; Mortality; Pneumonia