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Fluoroquinolone treatment of community-acquired pneumonia: a meta-analysis
Alan R Salkind1, Paul G Cuddy, John W Foxworth
1Department of Medicine, Section of Infectious Diseases, School of Medicine, University of Missouri-Kansas City, 64108, USA. salkinda@umkc.edu
Objective:
To determine the role of newer fluoroquinolones (FQs) for adults with community-acquired pneumonia (CAP) whose level of illness allows treatment with an oral antibiotic.
Methods:
Meta-analysis of randomized controlled trials comparing a macrolide, beta-lactam, or doxycycline antibiotic with a newer oral FQ for the treatment of CAP.
Results:
Patients (5118), most of whom were <60 years of age and free of coexisting diseases, were enrolled in 13 studies comparing an oral macrolide or beta-lactam antibiotic with an FQ for the treatment of CAP. No previous study compared doxycycline with an FQ. In the intention-to-treat (ITT) population, no trial demonstrated significant differences between FQs or alternative therapies. Summary estimates showed a statistically significant advantage in favor of the FQs in both the ITT (OR 1.22; 95% CI 1.02 to 1.47; p = 0.03) and evaluable populations (OR 1.37; 95% CI 1.11 to 1.68; p = 0.003). The number needed to treat for an FQ advantage was 33 (95% CI 17 to 362) in the ITT population and 37 (95% CI 22 to 121) in the evaluable population. Treatment failures represented slow symptom resolution; no deaths were reported.
Conclusions:
The newer oral FQs showed modest therapeutic benefit compared with the studied alternative antibiotics in adults with CAP. Based on the number needed to treat from the ITT population as a measure of treatment effect, clinicians must decide whether treating 33 patients with an FQ to prevent a single therapeutic failure with another studied antibiotic warrants use of an agent from that class for an illness with a generally favorable outcome regardless of antibiotic selection, and at a time when FQ resistance may be increasing.
Insights
Newer oral fluoroquinolones (FQs) offer a modest benefit for community-acquired pneumonia (CAP) in adults. Clinicians should weigh this small advantage against potential increasing fluoroquinolone resistance.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Community-acquired pneumonia (CAP) is a common infection requiring effective oral antibiotic treatment.
- The role of newer fluoroquinolones (FQs) in treating mild to moderate CAP is an area of ongoing clinical interest.
- Understanding the comparative efficacy of FQs versus alternative oral antibiotics is crucial for treatment guidelines.
Purpose of the Study:
- To evaluate the efficacy of newer oral fluoroquinolones (FQs) compared to macrolides, beta-lactams, or doxycycline for treating community-acquired pneumonia (CAP) in adults.
- To determine the therapeutic benefit and number needed to treat (NNT) for FQs in this patient population.
Main Methods:
- A meta-analysis of 13 randomized controlled trials (RCTs) was conducted.
- Studies compared newer oral FQs with macrolide, beta-lactam, or doxycycline antibiotics for CAP treatment.
- Data from 5118 patients were analyzed using intention-to-treat (ITT) and evaluable populations.
Main Results:
- No significant differences in treatment outcomes were found in individual trials.
- Meta-analysis revealed a statistically significant advantage for FQs in both ITT (OR 1.22) and evaluable (OR 1.37) populations.
- The number needed to treat for an FQ advantage was 33 in the ITT population; no deaths were reported.
Conclusions:
- Newer oral FQs demonstrate a modest therapeutic benefit over alternative oral antibiotics for CAP in adults.
- The decision to use FQs should consider the small NNT and the generally favorable prognosis of CAP.
- Increasing fluoroquinolone resistance is a critical factor for clinicians to consider when selecting antibiotic therapy.