Department of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, China.
Department of General Medicine, Daxing District People's Hospital, Capital Medical University, Beijing, China.
J Glob Antimicrob Resist. 2022 Sep;30:1-9. doi: 10.1016/j.jgar.2022.05.009. Epub 2022 May 26.
This network meta-analysis aimed to compare the efficacy and safety of fluoroquinolone (FQ) monotherapy, β-lactam (BL) monotherapy and β-lactam/macrolide (BL-M) combination therapy in hospitalized patients with community-acquired pneumonia (CAP).
Pubmed, Embase and the Cochrane Library were searched for randomized controlled trials (RCTs) comparing FQ monotherapy, BL monotherapy and BL-M combination therapy up to July 2021. The outcomes of interest included all-cause mortality, clinical success, microbiological success and drug-related adverse events. The summary relative risks (RRs) were estimated using pairwise and Bayesian network meta-analysis.
A total of 12 RCTs involving 5009 patients were included. In pairwise meta-analysis, no significant differences were found among FQ monotherapy, BL monotherapy and BL-M dual therapy for all-cause mortality, clinical success or microbiological success. FQ monotherapy was associated with fewer adverse events compared with BL-M therapy (RR 0.80, 95% confidence interval [CI] 0.66-0.98). The network meta-analysis showed that there was no significant difference observed among FQ monotherapy, BL monotherapy and BL-M dual therapy regarding all the outcomes.
FQ monotherapy, BL monotherapy and BL-M combination therapy demonstrated similar efficacy and safety for hospitalized patients with CAP in this network meta-analysis. Due to the limitations of quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.
本网络荟萃分析旨在比较氟喹诺酮（FQ）单药治疗、β-内酰胺（BL）单药治疗和 BL-大环内酯（BL-M）联合治疗在住院社区获得性肺炎（CAP）患者中的疗效和安全性。
检索 Pubmed、Embase 和 Cochrane 图书馆截至 2021 年 7 月的比较 FQ 单药治疗、BL 单药治疗和 BL-M 联合治疗的随机对照试验（RCT）。主要结局指标包括全因死亡率、临床疗效、微生物学疗效和药物相关不良事件。采用成对和贝叶斯网络荟萃分析估计汇总相对风险（RR）。
共纳入 12 项 RCT，涉及 5009 例患者。在成对荟萃分析中，FQ 单药治疗、BL 单药治疗和 BL-M 双重治疗在全因死亡率、临床疗效或微生物学疗效方面均无显著差异。FQ 单药治疗与 BL-M 治疗相比，不良反应发生率较低（RR 0.80，95%置信区间 [CI] 0.66-0.98）。网络荟萃分析显示，FQ 单药治疗、BL 单药治疗和 BL-M 双重治疗在所有结局方面均无显著差异。
在本网络荟萃分析中，FQ 单药治疗、BL 单药治疗和 BL-M 联合治疗对住院 CAP 患者的疗效和安全性相似。由于纳入研究的质量和数量存在局限性，在进行更多大规模、高质量 RCT 之前，很难做出明确的推荐。
