| Empirical atypical coverage for inpatients with community-acquired pneumonia: systematic review of randomized controlled trials. | |
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MedLine Citation:
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PMID: 16186469 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 beta-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. |
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Authors:
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Daphna Shefet; Eyal Robenshtok; Mical Paul; Leonard Leibovici |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Archives of internal medicine Volume: 165 ISSN: 0003-9926 ISO Abbreviation: Arch. Intern. Med. Publication Date: 2005 Sep |
Date Detail:
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Created Date: 2005-09-27 Completed Date: 2005-11-01 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0372440 Medline TA: Arch Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 1992-2000 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine E, Beilinson Campus, Rabin Medical Center, Petah-Tiqva, Israel. dshefet@yahoo.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Anti-Bacterial Agents
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therapeutic use* Community-Acquired Infections / drug therapy*, mortality Humans Pneumonia, Bacterial / drug therapy*, mortality Randomized Controlled Trials as Topic Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents |
| Comments/Corrections | |
Comment In:
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Evid Based Med. 2006 Jun;11(3):74
[PMID:
17213096
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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