Meta-analysis of the effects of combination therapies of β-lactams and fluoroquinolones or macrolides in the treatment of community-acquired pneumonia.

OBJECTIVE

The purpose of this study was to identify the optimal treatment plan for hospitalized patients with community-acquired pneumonia (CAP) by evaluating related studies on combination therapies of β-lactams/macrolides (BLM) and β-lactams/fluoroquinolones (BLFQ) in the treatment of CAP.

METHODS

A meta-analysis was performed on studies with mortality rates as the main result using PubMed, Scopus, Cochrane, and other journal databases. The literature was evaluated using GRADE and MiNORS.

RESULTS

A total of 17 studies were included. Various studies included the effects of combination therapy and mortality rates of β-lactam, fluoroquinolones and macrolides. The quality of currently available evidence was low. In the preliminary data analysis, the mortality rate of BLFQ was higher than that of BLM (RR = 1.33, 95% CI: 1.15-1.54, I = 28%). No difference was observed in patients with bacteremia and septic shock. In a meta-analysis with adjusted mortality rates, no significant difference was shown in two therapies (RR = 1.26, 95% CI: 0.95-1.67, I = 43%).

CONCLUSION

The related studies on the relative effects of BLFQ and BLM therapies in the treatment of CAP hospitalized patients have low-quality evidence. The current data indicate that BLFQ combination therapy is associated with higher mortality rates.