Abstract | BACKGROUND: METHODS: We searched PubMed, Current Contents, Scopus, EMBASE, ClinicalTrials.gov and Cochrane with no language restrictions. Two reviewers independently extracted data from published trials that compared fluoroquinolones ( levofloxacin, moxifloxacin, gemifloxacin) with macrolides or beta-lactams or both. A meta-analysis was performed with the clinical outcomes of mortality, treatment success and adverse outcomes. RESULTS: We included 23 trials in our meta-analysis. There was no difference in mortality among patients who received fluoroquinolones or the comparator antibiotics (OR 0.85, 95% CI 0.65-1.12). Pneumonia resolved in more patients who received fluoroquinolones compared with the comparator antibiotics for the included outcomes in the intention-to-treat population (OR 1.17, 95% CI 1.00-1.36), clinically evaluable population (OR 1.26, 95% CI 1.06-1.50) and the microbiologically assessed population (OR 1.67, 95% CI 1.28-2.20). Fluoroquinolones were more effective than a combination of beta-lactam and macrolide (OR 1.39, 95% CI 1.02-1.90). They were also more effective for patients with severe pneumonia (OR 1.84, 95% CI 1.02-3.29), those who required admission to hospital (OR = 1.30, 95% CI 1.04-1.61) and those who required intravenous therapy (OR = 1.44, 15% CI 1.13-1.85). Fluoroquinolones were more effective than beta-lactam and macrolide in open-label trials (OR = 1.35, 95% CI 1.08-1.69) but not in blinded randomized controlled trials (OR = 1.13, 95% CI 0.85-1.50). INTERPRETATION:
Fluoroquinolones were associated with higher success of treatment for severe forms of pneumonia; however, a benefit in mortality was not evident. A randomized controlled trial that includes patients with severe pneumonia with or without bacteremia is needed.
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Authors | Konstantinos Z Vardakas, Ilias I Siempos, Alexandros Grammatikos, Zoe Athanassa, Ioanna P Korbila, Matthew E Falagas |
Journal | CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
(CMAJ)
Vol. 179
Issue 12
Pg. 1269-77
(Dec 02 2008)
ISSN: 1488-2329 [Electronic] Canada |
PMID | 19047608
(Publication Type: Comparative Study, Journal Article, Meta-Analysis)
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Chemical References |
- Anti-Bacterial Agents
- Fluoroquinolones
- Macrolides
- beta-Lactams
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Topics |
- Anti-Bacterial Agents
(adverse effects, therapeutic use)
- Chi-Square Distribution
- Community-Acquired Infections
(drug therapy)
- Drug Therapy, Combination
- Fluoroquinolones
(adverse effects, therapeutic use)
- Humans
- Length of Stay
- Macrolides
(adverse effects, therapeutic use)
- Odds Ratio
- Pneumonia
(drug therapy, mortality)
- Randomized Controlled Trials as Topic
- Treatment Outcome
- beta-Lactams
(adverse effects, therapeutic use)
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