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Research Articles |
OBJECTIVE: To determine the role of newer fluoroquinolones (FQs) for adults with community-acquired pneumonia (CAP) whose level of illness allows treatment with an oral antibiotic. METHODS: Meta-analysis of randomized controlled trials comparing a macrolide, beta-lactam, or doxycycline antibiotic with a newer oral FQ for the treatment of CAP. RESULTS: Patients (5118), most of whom were <60 years of age and free of coexisting diseases, were enrolled in 13 studies comparing an oral macrolide or beta-lactam antibiotic with an FQ for the treatment of CAP. No previous study compared doxycycline with an FQ. In the intention-to-treat (ITT) population, no trial demonstrated significant differences between FQs or alternative therapies. Summary estimates showed a statistically significant advantage in favor of the FQs in both the ITT (OR 1.22; 95% CI 1.02 to 1.47; p = 0.03) and evaluable populations (OR 1.37; 95% CI 1.11 to 1.68; p = 0.003). The number needed to treat for an FQ advantage was 33 (95% CI 17 to 362) in the ITT population and 37 (95% CI 22 to 121) in the evaluable population. Treatment failures represented slow symptom resolution; no deaths were reported. CONCLUSIONS: The newer oral FQs showed modest therapeutic benefit compared with the studied alternative antibiotics in adults with CAP. Based on the number needed to treat from the ITT population as a measure of treatment effect, clinicians must decide whether treating 33 patients with an FQ to prevent a single therapeutic failure with another studied antibiotic warrants use of an agent from that class for an illness with a generally favorable outcome regardless of antibiotic selection, and at a time when FQ resistance may be increasing.
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  O. Leroy, P. Saux, J.-P. Bedos, E. Caulin, and for the Levofloxacin Study Group Comparison of Levofloxacin and Cefotaxime Combined With Ofloxacin for ICU Patients With Community-Acquired Pneumonia Who Do Not Require Vasopressors Chest, July 1, 2005; 128(1): 172 - 183. [Abstract] [Full Text] [PDF]
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V. L. Yu, R. N. Greenberg, N. Zadeikis, J. E. Stout, M. M. Khashab, W. H. Olson, and A. M. Tennenberg Levofloxacin Efficacy in the Treatment of Community-Acquired Legionellosis Chest, June 1, 2004; 125(6): 2135 - 2139. [Abstract] [Full Text] [PDF]
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 J T Macfarlane and D Boldy 2004 update of BTS pneumonia guidelines: what's new? Thorax, May 1, 2004; 59(5): 364 - 366. [Full Text] [PDF]
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