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Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis

¹ Pulmonology Institute, Soroka Medical Center, Faculty of Medicine, Ben-Gurion University of the Negev, Beersheba, Israel, ² Mahidol University, Dept of Medicine, Division of Ambulatory Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand. ³ University of Toronto, Dept of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada.

CORRESPONDENCE: T. K. Marras, Toronto Western Hospital, 7E-452, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. Fax: 1 4166035375. E-mail: ted.marras{at}utoronto.ca

Keywords: Antibiotic, community-acquired pneumonia, outpatient, treatment

Received: August 20, 2007
Accepted January 8, 2008

The aim of the present study was to systematically compare outcomes between antibiotic classes in treating outpatient community-acquired pneumonia, with regard to antibacterials active against atypical organisms, as well as between various antibacterial classes with similar atypical coverage.

A meta-analysis was performed on randomised controlled trials of antibacterials for community-acquired pneumonia in outpatients aged 18 yrs. The studies were independently reviewed by two reviewers. Clinical success and mortality were compared between different oral antibiotic classes, and antibacterials with atypical coverage (macrolides and fluoroquinolones) were specifically compared with other antibacterials.

In total, 13 eligible studies involving a total of 4,314 patients were included. The quality of the studies was variable. Five studied macrolides and fluoroquinolones, three macrolides and β-lactams, three fluoroquinolones and β-lactams and two cephalosporins versus β-lactams/ β-lactamase inhibitors. No significant difference was detected regarding clinical success or mortality, regardless of atypical coverage or between antibacterial classes with similar atypical coverage.

It was not possible to demonstrate any advantage of specific antibacterials for mild community-acquired pneumonia in relatively healthy outpatients. The need for coverage of atypical pathogens in this setting was not apparent. In mild-to-moderate cases of outpatient-treated community-acquired pneumonia, it might be most appropriate to select antibacterials according to side-effects, patient preferences, availability and cost.