Prizão Vitória Martins, Martins Otavio Cosendey, de Hollanda Morais Beatriz Austregésilo de Athayde, Mendes Beatriz Ximenes, Defante Maria Luiza Rodrigues, de Moura Souza Mariana
Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil.
Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
Eur J Clin Pharmacol. 2025 Jan;81(1):83-91. doi: 10.1007/s00228-024-03775-6. Epub 2024 Nov 18.
This study aims to evaluate whether adding macrolides (MAC) to beta-lactam (BL) monotherapy in the treatment of community-acquired pneumonia (CAP) offers clinical benefits that justify the potential disadvantages or side effects.
We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing BL monotherapy to combination therapy with BL and MAC for the in-hospital treatment of CAP. We pooled mean differences (MD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CI).
Six RCTs with 2661 participants (52% receiving combination therapy), revealed no significant difference in in-hospital mortality (RR 0.99; 95% CI 0.78 to 1.25; p = 0.94; I2 = 0%), 90-day mortality (RR 1.03; 95% CI 0.82 to 1.29; p = 0.83; I2 = 13%), or 30-day mortality (RR 0.90; 75% CI 0.63 to 1.29; p = 0.58; I2 = 54%). Additionally, no significant differences were observed in the length of hospital stay (MD 0.51; 95% CI - 0.50 to 1.51; p = 0.33; I2 = 63%) or respiratory insufficiency (RR 0.63; 95% CI 0.29 to 1.35; p = 0.24; I2 = 74%). However, combination therapy significantly improved the treatment success rate (RR 1.17; 95% CI 1.04 to 1.32; p = 0.009; I2 = 0%).
Our findings suggest that BL + MAC therapy should not be used in all cases of hospitalized patients with CAP.
CRD42024516383 - Data of registration: 03/03/2024.
本研究旨在评估在社区获得性肺炎（CAP）治疗中，在β-内酰胺（BL）单药治疗基础上加用大环内酯类药物（MAC）是否能带来临床益处，以证明其潜在的不利因素或副作用是合理的。
我们系统检索了PubMed、Embase和Cochrane数据库，以查找比较BL单药治疗与BL联合MAC治疗用于CAP住院治疗的随机对照试验（RCT）。我们汇总了连续结局的平均差（MD）和二分类结局的风险比（RR），并给出95%置信区间（CI）。
六项RCT共纳入2661名参与者（52%接受联合治疗），结果显示在院内死亡率（RR 0.99；95%CI 0.78至1.25；p = 0.94；I² = 0%）、90天死亡率（RR 1.03；95%CI 0.82至1.29；p = 0.83；I² = 13%）或30天死亡率（RR 0.90；75%CI 0.63至1.29；p = 0.58；I² = 54%）方面无显著差异。此外，在住院时间（MD 0.51；95%CI -0.50至1.51；p = 0.33；I² = 63%）或呼吸功能不全（RR 0.63；95%CI 0.29至1.35；p = 0.24；I² = 74%）方面也未观察到显著差异。然而，联合治疗显著提高了治疗成功率（RR 1.17；95%CI 1.04至1.32；p = 0.009；I² = 0%）。
我们的研究结果表明，BL + MAC治疗不应在所有住院CAP患者中使用。
PROSPERO注册号：CRD42024516383 - 注册日期：2024年3月3日。
