Antibiotic for community-acquired pneumonia in hospitalized adults: A systematic review and Bayesian network meta-analysis.

BACKGROUND

Inconsistent results have been obtained with various antibiotics for community-acquired pneumonia (CAP) in hospitalized adults. We performed a Bayesian network meta-analysis to compare and rank the effectiveness of antibiotics for adult patients with CAP.

METHODS

The databases of PubMed, Embase, and the Cochrane library were systematically searched until May 2025, for randomized controlled trials (RCTs) comparing at least two antibiotics for hospitalized adults with CAP. The investigated outcomes included clinical failure, bacteriological failure, mortality, total adverse events, gastrointestinal events, and requiring discontinuation of treatment.

RESULTS

Forty RCTs involving 12,838 hospitalized adults with CAP were selected for the final meta-analysis. The surface under the cumulative ranking probabilities (Surface Under the Cumulative Ranking Area, SUCRA; higher values indicate a greater likelihood of a treatment being the most effective) found that trovafloxacin (SUCRA: 87 %) and teicoplanin (SUCRA: 85 %) provided relatively better effects on clinical failure. Clarythromycin-ceftriaxone (SUCRA: 77 %) had the best effect for risk of bacteriological failure. Amoxicillin-clavulanate provided the optimal effect for reducing the risk of mortality (SUCRA: 82 %). The risk of total adverse events was lowest on using doxycycline (SUCRA: 86 %). Doxycycline (SUCRA: 89 %) and omadacycline (SUCRA: 80 %) provided relatively lower risk of gastrointestinal events. Finally, the use of ciprofloxacin was associated with the lowest risk of requiring discontinuation of treatment (SUCRA: 77 %).

CONCLUSIONS

This study provided an overview of the optimal antibiotics in management of adult patients with CAP, based on treatment effectiveness and safety profiles.