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J Korean Med Sci. 2017 Jan;32(1):77-84. doi: 10.3346/jkms.2017.32.1.77.

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.

Author information

1
Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.
2
Institute for Evidence-based Medicine, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
3
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea. yhkim2007@hotmail.co.kr.

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.

KEYWORDS:

Fluoroquinolone; Intensive Care Units; Macrolides; Mortality; Pneumonia

PMID:
27914135
PMCID:
PMC5143302
DOI:
10.3346/jkms.2017.32.1.77
[Indexed for MEDLINE]
Free PMC Article

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