Empirical antibiotic treatment strategies for community-acquired pneumonia: a network meta-analysis
Objectives: This network meta-analysis aimed to compare the efficacy and safety of fluoroquinolone (FQ) monotherapy, β-lactam (BL) monotherapy and β-lactam/macrolide (BL-M) combination therapy in hospitalized patients with community-acquired pneumonia (CAP). Methods: Pubmed, Embase and the Cochrane...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | Journal of Global Antimicrobial Resistance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716522001138 |
| _version_ | 1811274063137472512 |
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| author | Lu-Yan Xu Can-Can Wang Xiao-Xiao Peng Ying Jiao Cui-Zhu Zhao Li Zhang Li Ma |
| author_facet | Lu-Yan Xu Can-Can Wang Xiao-Xiao Peng Ying Jiao Cui-Zhu Zhao Li Zhang Li Ma |
| author_sort | Lu-Yan Xu |
| collection | DOAJ |
| description | Objectives: This network meta-analysis aimed to compare the efficacy and safety of fluoroquinolone (FQ) monotherapy, β-lactam (BL) monotherapy and β-lactam/macrolide (BL-M) combination therapy in hospitalized patients with community-acquired pneumonia (CAP). Methods: Pubmed, Embase and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing FQ monotherapy, BL monotherapy and BL-M combination therapy up to July 2021. The outcomes of interest included all-cause mortality, clinical success, microbiological success and drug-related adverse events. The summary relative risks (RRs) were estimated using pairwise and Bayesian network meta-analysis. Results: A total of 12 RCTs involving 5009 patients were included. In pairwise meta-analysis, no significant differences were found among FQ monotherapy, BL monotherapy and BL-M dual therapy for all-cause mortality, clinical success or microbiological success. FQ monotherapy was associated with fewer adverse events compared with BL-M therapy (RR 0.80, 95% confidence interval [CI] 0.66–0.98). The network meta-analysis showed that there was no significant difference observed among FQ monotherapy, BL monotherapy and BL-M dual therapy regarding all the outcomes. Conclusion: FQ monotherapy, BL monotherapy and BL-M combination therapy demonstrated similar efficacy and safety for hospitalized patients with CAP in this network meta-analysis. Due to the limitations of quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted. |
| first_indexed | 2024-04-12T23:12:11Z |
| format | Article |
| id | doaj.art-e5665a9a1cf94551bc63cac9b8e07776 |
| institution | Directory Open Access Journal |
| issn | 2213-7165 |
| language | English |
| last_indexed | 2024-04-12T23:12:11Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj.art-e5665a9a1cf94551bc63cac9b8e077762022-12-22T03:12:47ZengElsevierJournal of Global Antimicrobial Resistance2213-71652022-09-013019Empirical antibiotic treatment strategies for community-acquired pneumonia: a network meta-analysisLu-Yan Xu0Can-Can Wang1Xiao-Xiao Peng2Ying Jiao3Cui-Zhu Zhao4Li Zhang5Li Ma6Corresponding author: Department of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing 102600, China.; Department of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, ChinaDepartment of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, ChinaDepartment of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, ChinaDepartment of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, ChinaDepartment of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, ChinaDepartment of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, ChinaDepartment of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, ChinaObjectives: This network meta-analysis aimed to compare the efficacy and safety of fluoroquinolone (FQ) monotherapy, β-lactam (BL) monotherapy and β-lactam/macrolide (BL-M) combination therapy in hospitalized patients with community-acquired pneumonia (CAP). Methods: Pubmed, Embase and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing FQ monotherapy, BL monotherapy and BL-M combination therapy up to July 2021. The outcomes of interest included all-cause mortality, clinical success, microbiological success and drug-related adverse events. The summary relative risks (RRs) were estimated using pairwise and Bayesian network meta-analysis. Results: A total of 12 RCTs involving 5009 patients were included. In pairwise meta-analysis, no significant differences were found among FQ monotherapy, BL monotherapy and BL-M dual therapy for all-cause mortality, clinical success or microbiological success. FQ monotherapy was associated with fewer adverse events compared with BL-M therapy (RR 0.80, 95% confidence interval [CI] 0.66–0.98). The network meta-analysis showed that there was no significant difference observed among FQ monotherapy, BL monotherapy and BL-M dual therapy regarding all the outcomes. Conclusion: FQ monotherapy, BL monotherapy and BL-M combination therapy demonstrated similar efficacy and safety for hospitalized patients with CAP in this network meta-analysis. Due to the limitations of quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.http://www.sciencedirect.com/science/article/pii/S2213716522001138Community-acquired pneumoniaβ-lactamsMacrolidesFluoroquinolonesNetwork meta-analysis |
| spellingShingle | Lu-Yan Xu Can-Can Wang Xiao-Xiao Peng Ying Jiao Cui-Zhu Zhao Li Zhang Li Ma Empirical antibiotic treatment strategies for community-acquired pneumonia: a network meta-analysis Journal of Global Antimicrobial Resistance Community-acquired pneumonia β-lactams Macrolides Fluoroquinolones Network meta-analysis |
| title | Empirical antibiotic treatment strategies for community-acquired pneumonia: a network meta-analysis |
| title_full | Empirical antibiotic treatment strategies for community-acquired pneumonia: a network meta-analysis |
| title_fullStr | Empirical antibiotic treatment strategies for community-acquired pneumonia: a network meta-analysis |
| title_full_unstemmed | Empirical antibiotic treatment strategies for community-acquired pneumonia: a network meta-analysis |
| title_short | Empirical antibiotic treatment strategies for community-acquired pneumonia: a network meta-analysis |
| title_sort | empirical antibiotic treatment strategies for community acquired pneumonia a network meta analysis |
| topic | Community-acquired pneumonia β-lactams Macrolides Fluoroquinolones Network meta-analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2213716522001138 |
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