 |
|
Empirical Atypical Coverage for Inpatients With Community-Acquired Pneumonia
Systematic Review of Randomized Controlled Trials
Daphna Shefet, MD;
Eyal Robenshtok, MD;
Mical Paul, MD;
Leonard Leibovici, MD
Arch Intern Med. 2005;165:1992-2000.
Background Current guidelines of empirical antibiotic treatment for inpatients with community-acquired pneumonia recommend antibiotics whose spectrum covers intracellular (atypical) pathogens. No sufficient evidence exists to support the necessity of such coverage, whereas limiting it may reduce toxic effects, resistance, and expense. Our goal was to assess the efficacy of empirical coverage of atypical pathogens in terms of mortality and clinical and bacteriological success.
Methods Systematic review and meta-analysis of randomized, controlled trials comparing treatment regimens with and without coverage of atypical pathogens. We searched MEDLINE, EMBASE, the Cochrane Library, and references. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using the fixed-effects model. The primary outcome assessed was all-cause mortality.
Results We included 24 trials encompassing 5015 patients. We found no studies of a drug without atypical coverage that compared it with the same drug supplemented with a drug with atypical coverage; nearly all compared a  -lactam with a single quinolone or macrolide. There was no difference in mortality between the 2 arms (RR, 1.13 [95% CI, 0.82-1.54]). Regimens with coverage of atypical pathogens showed a trend toward clinical success and a significant advantage to bacteriological eradication. Both disappeared when evaluating methodologically high-quality studies alone. These regimens further showed a significant advantage in clinical success for Legionella pneumophila, whereas no advantage for pneumococcal pneumonia was seen. There was no difference between study arms in the frequency of total adverse events.
Conclusion Empirical antibiotic coverage of atypical pathogens in hospitalized patients with community-acquired pneumonia showed no benefit of survival or clinical efficacy in this synthesis of randomized trials.
Author Affiliations: Department of Medicine E, Beilinson Campus, Rabin Medical Center, Petah-Tiqva, Israel (Drs Shefet, Robenshtok, Paul, and Leibovici); and Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel Aviv, Israel (Drs Paul and Leibovici).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials
Vardakas et al.
CMAJ 2008;179:1269-1277.
ABSTRACT
| FULL TEXT
Review: Novel targets in the management of pneumonia
Diaz et al.
Therapeutic Advances in Respiratory Disease 2008;2:387-400.
ABSTRACT
Point-of-care urinary pneumococcal antigen test in the emergency department for community acquired pneumonia
Weatherall et al.
Emerg. Med. J. 2008;25:144-148.
ABSTRACT
| FULL TEXT
Atypical Coverage for Community-acquired Pneumonia
Robenshtok et al.
Am. J. Respir. Crit. Care Med. 2007;176:1289-1289.
FULL TEXT
Atypical Coverage for Community-acquired Pneumonia
Arnold et al.
Am. J. Respir. Crit. Care Med. 2007;176:1289-1290.
FULL TEXT
Antibiotic coverage is atypical: evidence from randomised trials
Leibovici et al.
BMJ 2007;335:1109-1109.
FULL TEXT
The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis
Paul et al.
Eur Respir J 2007;30:525-531.
ABSTRACT
| FULL TEXT
Antibiotics Selection for Bacteremic Pneumonia
Dimopoulos and Metersky
Chest 2007;132:360-361.
FULL TEXT
Antibiotics for Bacteremic Pneumonia: Improved Outcomes With Macrolides but Not Fluoroquinolones
Metersky et al.
Chest 2007;131:466-473.
ABSTRACT
| FULL TEXT
Review: empirical atypical coverage does not reduce mortality in hospitalised patients with community acquired pneumonia
Morris
Evid. Based Med. 2006;11:74-74.
FULL TEXT
Impact of initial antibiotic choice on mortality from pneumococcal pneumonia
Aspa et al.
Eur Respir J 2006;27:1010-1019.
ABSTRACT
| FULL TEXT
Another Blow for Pneumonia Guidelines
JWatch Emergency Med. 2005;2005:6-6.
FULL TEXT
Empirical Atypical Coverage for Inpatients with CAP?
JWatch Infect. Diseases 2005;2005:8-8.
FULL TEXT
|
