Bai Fusheng, Li Xinming
Department of Neurology, Liaoning Province Jinqiu Hospital, Shenyang 110016, China.
Key Lab of Environmental Pollution and Microecology of Liaoning Province, Shenyang Medical College, Shenyang 110034, China.
Iran J Public Health. 2021 Jun;50(6):1108-1119. doi: 10.18502/ijph.v50i6.6410.
We aimed to review relevant randomized controlled trials to assess the relative clinical effects of antibiotic treatment of patients with community-acquired pneumonia (CAP).
In this meta-analysis, we identified relevant studies from PubMed, Cochrane, and Embase using appropriate keywords. Key pertinent sources in the literature were also reviewed and all articles published through Oct 2019 were considered for inclusion. For each study, we assessed the risk ratios (RRs) or mean difference combined with the 95% confidence interval (CI) to assess and synthesize outcomes.
Overall, 36 studies were consistent with the meta-analysis, involving 17,076 patients. There was no significant difference in the mortality after subgroup analysis: individualized treatment vs. standard treatment; β-lactams plus macrolides vs. β-lactam and/or fluoroquinolone; ceftaroline fosamil vs. ceftriaxone; combination therapy vs. monotherapy or high-dose vs. low-dose. The drug-related adverse event incidence was significantly higher in the ceftriaxone group than in the other drug groups (<0.05) and also higher in the tigecyline group than in the levofloxacin group (<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the test-of-cure (TOC) visit in the clinically evaluable population, modified intent-to-treat efficacy (MITTE) population, microbiologically evaluable (ME) population and the microbiological MITTE (mMITTE) population (all <0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the TOC visit in the mMITTE population of Gram positive- (<0.05) and multidrug-resistant (<0.05).
There was a limited number of included studies in the subgroup analysis, but it will still be necessary to conduct more high-quality randomized controlled trials to confirm the clinical efficacy of different antibiotics used to treat CAP.
我们旨在回顾相关随机对照试验，以评估社区获得性肺炎（CAP）患者抗生素治疗的相对临床效果。
在这项荟萃分析中，我们使用适当的关键词从PubMed、Cochrane和Embase中识别相关研究。还对文献中的关键相关来源进行了回顾，并考虑纳入截至2019年10月发表的所有文章。对于每项研究，我们评估风险比（RRs）或均值差并结合95%置信区间（CI）来评估和综合结果。
总体而言，36项研究与荟萃分析一致，涉及17076名患者。亚组分析后死亡率无显著差异：个体化治疗与标准治疗；β-内酰胺类加大环内酯类与β-内酰胺类和/或氟喹诺酮类；头孢洛林酯与头孢曲松；联合治疗与单药治疗或高剂量与低剂量。头孢曲松组的药物相关不良事件发生率显著高于其他药物组（<0.05），替加环素组也高于左氧氟沙星组（<0.05）。与头孢曲松相比，头孢洛林酯在临床可评估人群、改良意向性治疗疗效（MITTE）人群、微生物学可评估（ME）人群和微生物学MITTE（mMITTE）人群的治愈试验（TOC）访视时显著提高了临床治愈率（均<0.05）。与头孢曲松相比，头孢洛林酯在革兰氏阳性（<0.05）和多重耐药（<0.05）的mMITTE人群中TOC访视时显著提高了临床治愈率。
亚组分析中纳入的研究数量有限，但仍有必要进行更多高质量的随机对照试验，以确认用于治疗CAP的不同抗生素的临床疗效。
