Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy · 2020
Meta-analysis of fluoroquinolones versus macrolides for treatment of legionella pneumonia.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Kato Hideo, Hagihara Mao, Asai Nobuhiro, Shibata Yuichi, Koizumi Yusuke, Yamagishi Yuka, Mikamo Hiroshige
Аннотация
BACKGROUND: Only a single meta-analysis has reported the clinical benefit of fluoroquinolones (FQs) for Legionella pneumonia; however, there is no robust data available to confirm this result, based on current guidelines.
METHODS: We performed a systematic review and meta-analysis comparing FQs with macrolides (MCs) on their efficacy and safety in Legionella pneumonia, using studies published until January 2020. The outcomes included mortality (overall; 30-day), clinical cure, time to apyrexia, length of hospital stay, and adverse events.
RESULTS: Five RCTs and twelve retrospective studies were identified. Clinical cure was comparable between the treatment groups (risk rate (RR) 1.07, 95% confidential interval (CI) 0.86-1.31). Mortality was significantly higher for MCs than for FQs (overall, odd rate (OR) 0.59, 95% CI 0.35-0.98; 30-day, OR 0.41, 95% CI 0.20-0.85). FQs significantly reduced the length of hospital stay, compared to MCs (mean difference -3.58, 95% CI -5.48-1.69). Other outcomes were not significantly different between the treatment groups (time to apyrexia; mean difference -1.83, 95% CI -5.15-1.5, adverse events; OR 0.61, 95% CI 0.33-1.15). In subgroup analyses, levofloxacin significantly reduced the length of hospital stay over two specific MCs (azithromycin and clarithromycin) (mean difference -3.03, 95% CI -5.33-0.72), whereas mortality was not significantly different between the treatment groups (overall, OR 0.49, 95% CI 0.19-1.24; 30-day, OR 0.38, 95% CI 0.13-1.13).
CONCLUSIONS: FQs exhibited superior effects in terms of mortality and length of hospital stay in Legionella pneumonia. These results support current guidelines recommending FQs for the treatment of Legionella pneumonia.
METHODS: We performed a systematic review and meta-analysis comparing FQs with macrolides (MCs) on their efficacy and safety in Legionella pneumonia, using studies published until January 2020. The outcomes included mortality (overall; 30-day), clinical cure, time to apyrexia, length of hospital stay, and adverse events.
RESULTS: Five RCTs and twelve retrospective studies were identified. Clinical cure was comparable between the treatment groups (risk rate (RR) 1.07, 95% confidential interval (CI) 0.86-1.31). Mortality was significantly higher for MCs than for FQs (overall, odd rate (OR) 0.59, 95% CI 0.35-0.98; 30-day, OR 0.41, 95% CI 0.20-0.85). FQs significantly reduced the length of hospital stay, compared to MCs (mean difference -3.58, 95% CI -5.48-1.69). Other outcomes were not significantly different between the treatment groups (time to apyrexia; mean difference -1.83, 95% CI -5.15-1.5, adverse events; OR 0.61, 95% CI 0.33-1.15). In subgroup analyses, levofloxacin significantly reduced the length of hospital stay over two specific MCs (azithromycin and clarithromycin) (mean difference -3.03, 95% CI -5.33-0.72), whereas mortality was not significantly different between the treatment groups (overall, OR 0.49, 95% CI 0.19-1.24; 30-day, OR 0.38, 95% CI 0.13-1.13).
CONCLUSIONS: FQs exhibited superior effects in terms of mortality and length of hospital stay in Legionella pneumonia. These results support current guidelines recommending FQs for the treatment of Legionella pneumonia.