Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis

Abstract

The aim of the present study was to systematically compare outcomes between antibiotic classes in treating outpatient community-acquired pneumonia, with regard to antibacterials active against atypical organisms, as well as between various antibacterial classes with similar atypical coverage.A meta-analysis was performed on randomised controlled trials of antibacterials for community-acquired pneumonia in outpatients aged ≥18 yrs. The studies were independently reviewed by two reviewers. Clinical success and mortality were compared between different oral antibiotic classes, and antibacterials with atypical coverage (macrolides and fluoroquinolones) were specifically compared with other antibacterials.In total, 13 eligible studies involving a total of 4,314 patients were included. The quality of the studies was variable. Five studied macrolides and fluoroquinolones, three macrolides and β-lactams, three fluoroquinolones and β-lactams and two cephalosporinsversusβ-lactams/ β-lactamase inhibitors. No significant difference was detected regarding clinical success or mortality, regardless of atypical coverage or between antibacterial classes with similar atypical coverage.It was not possible to demonstrate any advantage of specific antibacterials for mild community-acquired pneumonia in relatively healthy outpatients. The need for coverage of atypical pathogens in this setting was not apparent. In mild-to-moderate cases of outpatient-treated community-acquired pneumonia, it might be most appropriate to select antibacterials according to side-effects, patient preferences, availability and cost.

Guidelines for diagnosis and management of community-and hospital-acquired pneumonia in adults: Joint ICS/NCCP(I) recommendations

“…However, the need for empiric treatment of these organisms in mild CAP in the outpatient setting has been challenged as evidence suggests no benefit of covering these organisms with appropriate antibiotics in the outpatient setting. [90162163170176177] Combination therapy should be restricted to patients with severe pneumonia. [103120] Its advantages include expansion of the antimicrobial spectrum to include atypical pathogens and possibly immunomodulation.…”

Is Activity against “Atypical” Pathogens Necessary in the Treatment Protocols for Community‐Acquired Pneumonia? Issues with Combination Therapy

“…The review by Mills et al [38] showed similar resultsthat is, no improvement in clinical outcome with the use of antibiotics active against atypical pathogens, except among the subset of patients infected with L. pneumophila (table 2). The most recent report [37] reviewed studies from 1966 through July 2007 involving outpatients with CAP and concluded that there was no advantage to using specific antibacterials for treatment of mild CAP in otherwise healthy outpatients. A potential concern about these reports is that they tended to analyze the same studies.…”

“…On the basis of a literature review, there have been 3 metaanalyses performed to address this issue [36][37][38]. All 3 used the same study format with a review of comparative trials of agents showing activity against atypical pathogens (macrolides, fluoroquinolones, or tetracyclines) versus b-lactams.…”

Strategy of rational antibacterial therapy of acute exacerbation of chronic obstructive pulmonary disease: an approach based on minimal hazard risk

“…Однако значение этого феномена дискутабельно, более того, известно, что препараты, неактивные против атипичной микрофлоры (ингибиторзащи щенные аминопенициллины, цефалоспорины III по коления), эффективно элиминируя гемофильную инфекцию [34][35][36], быстро купируют обострение и обеспечивают более продолжительный период без обострений, чем, например, неактивные против ге мофильной палочки макролиды [34][35][36][37]. Эффектив ность β лактамов при атипичной инфекции, в част ности микоплазменной, отмечена в клинических исследованиях и метаанализах [38][39][40].…”