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, beta-lactam (BL) monotherapy and beta-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. (C) 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.

Automated summary

This network meta-analysis compared the efficacy and safety of fluoroquinolone monotherapy, beta-lactam monotherapy, and beta-lactam/macrolide combination therapy in CAP patients, finding no significant differences in key outcomes, but fewer adverse events associated with FQ monotherapy.