Effectiveness of β lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis

Mills, Graham; Oehley, Michael R; Arrol, Bruce

doi:10.1136/bmj.38334.591586.82

Cited by 164 publications

(100 citation statements)

References 36 publications

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“…Previous meta-analyses, although of high quality, have addressed somewhat different questions using different inclusion criteria [6,7]. BJERRE et al [6], although limiting their analysis to studies of outpatients, included studies in which all participants received therapy with atypical activity, making it impossible to address whether or not atypical coverage is helpful.…”

Section: Discussionmentioning

confidence: 99%

“…To the meta-analysis of BJERRE et al [6], the present study, therefore, adds an analysis of almost 1,200 patients in order to assess whether or not atypical therapy is useful in OCAP, an analysis of an additional 1,200 patients comparing macrolide versus fluoroquinolone therapy and analyses comparing other drug classes. MILLS et al [7] apparently included both in-patient and outpatient studies in their meta-analysis, and focused exclusively on whether atypical coverage is beneficial. Data are presented as n or n (%).…”

Section: Discussionmentioning

confidence: 99%

“…This meta-analysis, therefore, does not address the question as to whether atypical coverage is important in OCAP, and provides no information regarding antibacterials other than macrolides and one of the fluoroquinolones. In a second relevant meta-analysis, MILLS et al [7] compared the efficacy of antibacterials with activity against atypical pathogens versus b-lactams in nonsevere CAP. Their results are limited by the inclusion of only studies involving blactams in the group without atypical coverage, and of both inpatients and outpatients.…”

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confidence: 99%

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

Maimon¹,

Nopmaneejumruslers²,

Marras³

2008

Eur Respir J

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

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

Maimon¹,

Nopmaneejumruslers²,

Marras³

2008

Eur Respir J

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“…and C. pneumoniae were both found in three patients, which might explain why regimens covering these organisms did not substantially affect the outcome in the current study. Moreover, evidence is lacking that clinical outcomes are improved by using antibiotics that are active against atypical pathogens, at least in nonsevere CAP [31,32].…”

Section: Discussionmentioning

confidence: 99%

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Aspa¹,

Rajas²,

Castro³

et al. 2006

Eur Respir J

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To determine the impact of initial antimicrobial choice on 30-day mortality rate in patients with community-acquired pneumonia due to Streptococcus pneumoniae (CAP-SP), a prospective, observational study was conducted in 35 Spanish hospitals. A total of 638 patients with CAP-SP were identified. Antimicrobials were chosen by the attending physician. Patients were grouped into the following categories: b-lactam monotherapy (n5251), macrolide monotherapy (n537), b-lactam plus macrolide (n5198), levofloxacin alone/combination (n548), and other combinations (n5104). The reference category was b-lactam+macrolide.The 30-day survival probability was 84.9%. Using multivariate survival analysis, factors related to mortality in the entire population were: bilateral disease, suspected aspiration, shock, HIV infection, renal failure and pneumonia severity index (PSI) score Class IV versus I-III and categories V versus I-III. The association of b-lactams+macrolides was not better than the use of b-lactams alone. The current authors analysed the different groups of patients with significant mortality/morbidity: intensive care unit, PSI Class .III, renal failure, chronic lung disease and bacteraemia. Only in patients with PSI Class .III, who had undergone initial antimicrobial choice classified as other combinations, were associated with higher mortality.In conclusion, the current authors have not demonstrated an independent association between initial antimicrobial regimen and 30-day mortality in community-acquired pneumococcal pneumonia patients, except for those with a higher pneumonia severity index score.

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“…Similarly, Mills et al showed no advantage of antibiotics active against atypical pathogens over BL antibiotics in nonsevere CAP, again with the exception of patients with Legionella pneumonia (16).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic treatment outcomes in community-acquired pneumonia

Çilli¹,

Sayıner²,

Celenk³

et al. 2018

Turk J Med Sci

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Background/aim: The optimal empiric antibiotic regimen for patients with community-acquired pneumonia (CAP) remains unclear. This study aimed to evaluate the clinical cure rate, mortality, and length of stay among patients hospitalized with communityacquired pneumonia in nonintensive care unit (ICU) wards and treated with a β-lactam, β-lactam and macrolide combination, or a fluoroquinolone. Materials and methods:This prospective cohort study was performed using standardized web-based database sheets from January 2009 to September 2013 in nine tertiary care hospitals in Turkey.Results: Six hundred and twenty-one consecutive patients were enrolled. A pathogen was identified in 78 (12.6%) patients. The most frequently isolated bacteria were S. pneumoniae (21.8%) and P. aeruginosa (19.2%). The clinical cure rate and length of stay were not different among patients treated with β-lactam, β-lactam and macrolide combination, and fluoroquinolone. Forty-seven patients (9.2%) died during the hospitalization period. There was no difference in survival among the three treatment groups. Conclusion:In patients admitted to non-ICU hospital wards for CAP, there was no difference in clinical outcomes between β-lactam, β-lactam and macrolide combination, and fluoroquinolone regimens.

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Effectiveness of β lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis

Cited by 164 publications

References 36 publications

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

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

Impact of initial antibiotic choice on mortality from pneumococcal pneumonia

Antibiotic treatment outcomes in community-acquired pneumonia

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