Fluoroquinolone (FQ) monotherapy, β-lactam (BL) monotherapy, and β-lactam plus macrolide (BL-M) combination therapy demonstrated similar efficacy and safety for the treatment of community-acquired pneumonia (CAP), according to findings published in the Journal of Global Antimicrobial Resistance.

Researchers conducted a network meta-analysis, searching PubMed, Embase, and the Cochrane Register of Controlled Trials for studies published through July 2021 that assessed the efficacy of 3 different antibiotic regimens for adults hospitalized with CAP. Assessed treatments included FQ monotherapy, BL monotherapy, and BL-M combination therapy. The primary outcome was all-cause mortality; secondary outcomes included clinical and microbiologic success, and the incidence of adverse events (AEs).

There were 12 randomized controlled trials representing 5009 patients included in the analysis. Of these patients, the mean age was 64 years, and the duration of CAP treatment was between 5 and 16 days.


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FQ and BL monotherapies both demonstrated an insignificant decrease in the risk of mortality when compared with BL-M combination therapy (relative risk [RR], 0.77; 95% CI, 0.59-1.01 vs RR, 0.86, 95% CI, 0.52-1.44, respectively). Additionally, no significant difference in mortality risk was observed when FQ monotherapy was compared against BL monotherapy (RR, 1.02; 95% CI, 0.74-1.39).

The risk for AEs among patients with CAP was significantly decreased among those who received FQ monotherapy compared with those who received BL-M combination therapy (RR, 0.80, 95% CI, 0.66-0.98).  The decreased risk for AEs observed among patients who received FQ monotherapy did not significantly differ vs those who received BL monotherapy (RR, 0.61, 95% CI 0.35-1.07). Additionally, the researchers observed no significant difference in the occurrence of AEs between patients who received BL monotherapy vs those who received BL-M combination therapy (RR, 1.19; 95% CI, 0.70-2.03).

In regard to outcomes of microbiologic success and clinical success, no significant differences were noted between the 3 antibiotic regimens assessed.

Limitations included the small number of studies included in the analysis, of which most had an open-label design. In addition, the researchers were unable to assess the effect of CAP severity or drug resistance on treatment outcomes.

“More large-scale and high-quality RCTs in different regions are needed to confirm [these] findings,” the researchers concluded.

Reference

Xu L, Wang C, Peng X, et al. Empirical antibiotic treatment strategies for community-acquired pneumonia: A network meta-analysis. J Glob Antimicrob Resist. Published online May 25, 2022. doi:10.1016/j.jgar.2022.05.009