Empiric Therapy by Regimens with and without Coverage of Atypical Bacteria in Hospitalized adults with Community-Acquired Pneumonia: Meta-analysis
Both typical and atypical organisms can cause community-acquired pneumonia (CAP); however, the need for atypical coverage remains unclear. Prior meta-analyses of randomized controlled trials (RCTs) have not demonstrated the benefit of atypical coverage; but included studies of non-recommended comparators and/or added atypical coverage between agents with different typical coverage. One meta-analysis favoring atypical coverage did not include RCTs. Objectives of this meta-analysis were to evaluate the impact of antibiotic regimens with atypical coverage (a fluoroquinolone or combination of a macrolide/doxycycline with a β-lactam) to a regimen without atypical antibiotic coverage (β-lactam monotherapy) on rates of clinical failure (primary endpoint) and mortality (secondary endpoint).
We searched the PubMed, EMBASE and Cochrane databases for relevant RCTs of hospitalized CAP adults; without date restrictions and limiting languages to English, Arabic, French, German, Spanish, Italian, and Dutch. Five RCTs with a total of 2,011 pts were retained. We estimated risk ratios (RRs) with 95% confidence intervals (CIs) using random-effects models and assessed for consistency (I2).
998 patients treated with empiric atypical bacterial coverage were compared to 1013 patients treated with non-atypical bacterial coverage. A statistically significant lower clinical failure rate was observed with empiric atypical coverage (RR=0.851, 95% CI 0.732-0.99, p=0.037, I2=0%) (see figure). Mortality rates did not differ between treatment arms (RR=0.869, 95% CI 0.567-1.332, p=0.52, I2=0%).
Our meta-analysis showed that empiric atypical coverage is associated with a 14.9% reduction of clinical failure in hospitalized adults with CAP. No significant differences were found in terms of mortality.
A. Aljabri, None
I. Abraham, None
D. Nix, None
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