Macrolide-Based Regimens and Mortality in Hospitalized Patients with Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis.
Clin Infect Dis. 2012 Apr 16;
Authors: Asadi L, Sligl WI, Eurich DT, Colmers IN, Tjosvold L, Marrie TJ, Majumdar SR
BackgroundMacrolides are used to treat pneumonia despite increasing antimicrobial resistance. However, the immunomodulatory properties of macrolides may have a favorable effect on pneumonia outcomes. Therefore, we systematically reviewed all studies of macrolide use and mortality among patients hospitalized with community-acquired pneumonia (CAP).MethodsAll RCTs and observational studies comparing macrolides to other treatment regimens in adults hospitalized with CAP were identified through electronic databases and grey literature searches. Primary analysis examined any macrolide use and mortality; secondary analysis compared IDSA/ATS guideline-concordant macrolide/beta-lactam combinations vs. respiratory fluoroquinolones. Random effects models were used to generate pooled risk ratios (RR) and evaluate heterogeneity (I(2)).ResultsWe included 23 studies and 137,574 patients. Overall, macrolide use was associated with a statistically significant mortality reduction compared with non-macrolides (3.7% [1738 of 47071] vs. 6.5% [5861 of 90503]; RR 0.78; 95%CI 0.64-0.95; p=0.01; I(2)=85%). There was no survival advantage and heterogeneity was reduced when analyses were restricted to RCTs (4.6% [22 of 479] vs. 4.1% [25 of 613]; RR 1.13; 95%CI 0.65-1.98); p=0.66; I(2)=0%) or to patients treated with guideline-concordant antibiotics (macrolide/beta-lactam 5.3% [297 of 5574] vs. respiratory fluoroquinolones 5.8% [408 of 7050]; RR 1.17; 95%CI 0.91-1.50; p=0.22; I(2)=43%).ConclusionsIn hospitalized patients with CAP, macrolide-based regimens were associated with a significant 22% reduction in mortality compared to non-macrolides; however, this benefit did not extend to patients studied in RCTs or patients that received guideline-concordant antibiotics. Our findings suggest guideline-concordance is more important than choice of antibiotic when treating CAP.
PMID: 22511553 [PubMed - as supplied by publisher]Link to Article at PubMed