Efficacy of Empiric Macrolides versus Fluoroquinolones in Community-Acquired Pneumonia Associated with Atypical Bacteria: A Meta-analysis - 21/06/22

Doi : 10.1016/j.resmer.2022.100931

Ahmed Basilim, PharmD ¹, Haytham Wali, PharmD ², Ali A. Rabaan, PhD ^3,^4,⁵, Khalid Eljaaly, PharmD, MS, BCPS, BCIDP ^1,^⁎
¹ Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
² Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
³ Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
⁴ College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
⁵ Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan

^⁎Corresponding author and address for requests for reprints: Khalid Eljaaly, PharmD, MS, BCPS, BCIDP, Department of Pharmacy Practice, King Abdulaziz University, P.O. Box 80200, Jeddah, postal code 21589, Saudi Arabia; Tel: +966564362332Department of Pharmacy PracticeKing Abdulaziz UniversityP.O. Box 80200Jeddah21589Saudi Arabia

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Abstract

Introduction: It is unclear if one empiric regimen for community-acquired pneumonia (CAP) associated with atypical bacteria is superior to another. The objective of this meta-analysis was to compare fluoroquinolones to macrolides in the rates of clinical failure in CAP associated with atypical pathogens.

Methods: We searched PubMed and EMBASE databases for randomized controlled trials (RCTs) comparing the clinical efficacy of fluoroquinolones with macrolides for CAP associated with atypical bacteria. We estimated risk differences (RRs) with 95% confidence intervals (CIs) using random-effects models and assessed for heterogeneity (I²).

Results: Five RCTs met the inclusion criteria. No significant differences between macrolides and fluoroquinolones and were identified in rates of clinical failure in CAP associated with any atypical bacteria (RR = 1.57 [95% CI 0.73 to 3.38]; p = 0.251; I² = 0%), Chlamydia pneumoniae (RR = 2.12 [95% CI 0.63 to 7.14]; p = 0.223; I² = 0%), Mycoplasma pneumoniae (RR = 1.28 [95% CI 0.57 to 2.92]; p = 0.550; I² = 0%), or Legionella pneumophila (RR = 0.24 [95% CI 0.02 to 2.86]; p = 0.256; I² = 0%).

Conclusions: This meta-analysis of RCTs found no significant differences between macrolides and fluoroquinolones in rates of clinical failure in CAP associated with atypical bacteria.

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Key Words : Fluoroquinolone, Macrolide, Pneumonia, Atypical bacteria