Effectiveness of macrolides as add-on therapy to beta-lactams in community-acquired pneumonia: A meta-analysis of randomized controlled trials.

Autor: Prizão VM; Department of Medicine, State University of Maringá, Maringá, Paraná, Brazil. vitoriamprizao@gmail.com., Martins OC; Department of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil., de Hollanda Morais BAA; Department of Medicine, Cesmac University Center, Maceió, Alagoas, Brazil., Mendes BX; Department of Medicine, Christus University Center, Fortaleza, Ceará, Brazil., Defante MLR; Department of Medicine, Redentor University Center, Itaperuna, Rio de Janeiro, Brazil., de Moura Souza M; Department of Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil.
Jazyk: angličtina
Zdroj: European journal of clinical pharmacology [Eur J Clin Pharmacol] 2025 Jan; Vol. 81 (1), pp. 83-91. Date of Electronic Publication: 2024 Nov 18.
DOI: 10.1007/s00228-024-03775-6
Abstrakt: Purpose: 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.
Methods: 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).
Results: 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%).
Conclusion: Our findings suggest that BL + MAC therapy should not be used in all cases of hospitalized patients with CAP.
Prospero Id: CRD42024516383 - Data of registration: 03/03/2024.
Competing Interests: Declarations. Competing Interests: The authors declare no competing interests.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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