Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults

Abstract

No benefit of survival or clinical efficacy was shown with empirical atypical coverage in hospitalized patients with CAP. This conclusion relates mostly to the comparison of quinolone monotherapy to beta-lactams. Further trials, comparing beta-lactam monotherapy to the same combined with a macrolide, should be performed.

Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis

“…Our meta-analysis did not find a significant difference in mortality rates, which is consistent with other meta-analyses of RCTs [ 5 – 7 ]. Regimens that provided atypical coverage did not result in significantly more adverse events; however, adverse events were assessed in the studies involving respiratory fluoroquinolones and not in the macrolide-β-lactam combination study.…”

Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis

“…Our meta-analysis did not find a significant difference in mortality rates, which is consistent with other meta-analyses of RCTs [ 5 – 7 ]. Regimens that provided atypical coverage did not result in significantly more adverse events; however, adverse events were assessed in the studies involving respiratory fluoroquinolones and not in the macrolide-β-lactam combination study.…”

Antibiotic Therapy for Adults Hospitalized With Community-Acquired Pneumonia

“…Reviews of initial antibiotic selection also reached conflicting conclusions based in part on the types of studies included in their analyses. 41,42 Findings from the observational studies that we reviewed were consistent with a recent meta-analysis 41 with less stringent inclusion criteria comprising 16 observational studies, which demonstrated 33% lower odds of mortality with β-lactam plus macrolide combination therapy compared with β-lactam monotherapy. In contrast, a Cochrane review 42 of 28 predominately industry-funded randomized trials found no benefit in shortterm mortality or clinical success with empirical antibiotic regimens containing atypical coverage compared with regimens providing typical coverage only.…”

“…Reviews of initial antibiotic selection also reached conflicting conclusions based in part on the types of studies included in their analyses . Findings from the observational studies that we reviewed were consistent with a recent meta-analysis with less stringent inclusion criteria comprising 16 observational studies, which demonstrated 33% lower odds of mortality with β-lactam plus macrolide combination therapy compared with β-lactam monotherapy.…”

Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia

“…[10][11][12] Observational data from adults demonstrated improved outcomes associated with macrolide use in patients with lower respiratory infections, but these findings have not been replicated in randomized trials. [31][32][33][34] We observed that children receiving macrolides in combination with narrow-or broad-spectrum antibiotic therapy had lower odds of a change in antibiotic therapy during the follow-up period. We speculate that clinicians may be reluctuant to modify antibiotic therapy for a child who is already taking 2 antibiotics, although we have no direct evidence to support this theory.…”

Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis

“…Our meta-analysis did not find a significant difference in mortality rates, which is consistent with other meta-analyses of RCTs [ 5 – 7 ]. Regimens that provided atypical coverage did not result in significantly more adverse events; however, adverse events were assessed in the studies involving respiratory fluoroquinolones and not in the macrolide-β-lactam combination study.…”

Antibiotic Therapy for Adults Hospitalized With Community-Acquired Pneumonia

“…Reviews of initial antibiotic selection also reached conflicting conclusions based in part on the types of studies included in their analyses. 41,42 Findings from the observational studies that we reviewed were consistent with a recent meta-analysis 41 with less stringent inclusion criteria comprising 16 observational studies, which demonstrated 33% lower odds of mortality with β-lactam plus macrolide combination therapy compared with β-lactam monotherapy. In contrast, a Cochrane review 42 of 28 predominately industry-funded randomized trials found no benefit in shortterm mortality or clinical success with empirical antibiotic regimens containing atypical coverage compared with regimens providing typical coverage only.…”

“…Reviews of initial antibiotic selection also reached conflicting conclusions based in part on the types of studies included in their analyses . Findings from the observational studies that we reviewed were consistent with a recent meta-analysis with less stringent inclusion criteria comprising 16 observational studies, which demonstrated 33% lower odds of mortality with β-lactam plus macrolide combination therapy compared with β-lactam monotherapy.…”

Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia

“…[10][11][12] Observational data from adults demonstrated improved outcomes associated with macrolide use in patients with lower respiratory infections, but these findings have not been replicated in randomized trials. [31][32][33][34] We observed that children receiving macrolides in combination with narrow-or broad-spectrum antibiotic therapy had lower odds of a change in antibiotic therapy during the follow-up period. We speculate that clinicians may be reluctuant to modify antibiotic therapy for a child who is already taking 2 antibiotics, although we have no direct evidence to support this theory.…”

Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis

“…Our meta-analysis did not find a significant difference in mortality rates, which is consistent with other meta-analyses of RCTs [ 5 – 7 ]. Regimens that provided atypical coverage did not result in significantly more adverse events; however, adverse events were assessed in the studies involving respiratory fluoroquinolones and not in the macrolide-β-lactam combination study.…”

Antibiotic Therapy for Adults Hospitalized With Community-Acquired Pneumonia

“…Reviews of initial antibiotic selection also reached conflicting conclusions based in part on the types of studies included in their analyses. 41,42 Findings from the observational studies that we reviewed were consistent with a recent meta-analysis 41 with less stringent inclusion criteria comprising 16 observational studies, which demonstrated 33% lower odds of mortality with β-lactam plus macrolide combination therapy compared with β-lactam monotherapy. In contrast, a Cochrane review 42 of 28 predominately industry-funded randomized trials found no benefit in shortterm mortality or clinical success with empirical antibiotic regimens containing atypical coverage compared with regimens providing typical coverage only.…”

“…Reviews of initial antibiotic selection also reached conflicting conclusions based in part on the types of studies included in their analyses . Findings from the observational studies that we reviewed were consistent with a recent meta-analysis with less stringent inclusion criteria comprising 16 observational studies, which demonstrated 33% lower odds of mortality with β-lactam plus macrolide combination therapy compared with β-lactam monotherapy.…”

Antibiotic Choice and Clinical Outcomes in Ambulatory Children with Community-Acquired Pneumonia

“…[10][11][12] Observational data from adults demonstrated improved outcomes associated with macrolide use in patients with lower respiratory infections, but these findings have not been replicated in randomized trials. [31][32][33][34] We observed that children receiving macrolides in combination with narrow-or broad-spectrum antibiotic therapy had lower odds of a change in antibiotic therapy during the follow-up period. We speculate that clinicians may be reluctuant to modify antibiotic therapy for a child who is already taking 2 antibiotics, although we have no direct evidence to support this theory.…”