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SAN FRANSISCO — For patients with community-acquired pneumonia, an antibiotic regimen including a fluoroquinolone may reduce mortality risk by 1% to 2% compared with beta-lactams and cephalosporins alone, according to research presented at IDWeek 2018, held October 3-7, 2018, in San Francisco, California.
For this systematic review, network meta-analysis, and network meta-regression, researchers used a Bayesian framework to combine the knowledge of 303 randomized controlled trials from CENTRAL, EMBASE, and Medline, which occurred on or before March 17, 2017, that compared at least 2 empiric antibiotic regimens for patients with community-acquired pneumonia. Most of these trials were not blinded (69.9%), and all had low global heterogeneity. Investigators chose GRADE assessment of quality of evidence to evaluate the effect estimates certainty.
Of the 26,423 participants included in the analysis of mortality, 2.9% (n=726) died. Patients taking only third-generation cephalosporins had higher mortality rates than those taking cephalosporin-fluoroquinolone combinations (RR 3.21; 95% CI, .99-12.49), early generation fluoroquinolones (RR 2.08; 95% CI, 1.17-3.90), and later generation fluoroquinolones (RR 2.32; 95% CI, 1.44-4.26). Patients taking a combination of cephalosporin and macrolide were less likely to die than those only taking a third-generation cephalosporin (RR .47; 95% CI, .21-.99).
Of the 30,559 participants included in the analysis for treatment failure, the evidence was similar. Beta-lactam plus beta-lactamase inhibitors, daptomycin, and early generation cephalosporins were also associated with a higher mortality and/or treatment failure risk compared with most other antibiotic regimens. The GRADE assessment was low or moderate for key comparisons.
Study investigators concluded that “[i]n patients with [community-acquired pneumonia], an antibiotic regimen that includes a fluoroquinolone (and possibly a macrolide) may reduce mortality by approximately 1-2% compared to beta-lactams (with or without a betalactamase inhibitor) and cephalosporins alone.” However, they also noted that blinded, higher-quality, randomized evidence is needed to increase certainty.
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Siemieniuk R, Lee Y, Bogoch I, et al. Antibiotic therapy for community-acquired pneumonia: a systematic review and network meta-analysis of randomized trials. Presented at: IDWeek 2018; October 3-7, 2018; San Francisco, California.