Are Fluoroquinolones or Macrolides Better for Treating Legionella Pneumonia? A Systematic Review and Meta-analysis.

Anti-Bacterial Agents / therapeutic use Community-Acquired Infections / drug therapy Fluoroquinolones Humans Legionella Macrolides Male Middle Aged Pneumonia / drug therapy
Legionella pneumonia Legionnaire’s disease fluoroquinolones macrolides

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
01 06 2021
Historique:
received: 11 12 2019
accepted: 15 04 2020
pubmed: 17 4 2020
medline: 6 7 2021
entrez: 17 4 2020
Statut: ppublish

Résumé

The Infectious Diseases Society of America recommends either a fluoroquinolone or a macrolide as a first-line antibiotic treatment for Legionella pneumonia, but it is unclear which antibiotic leads to optimal clinical outcomes. We compared the effectiveness of fluoroquinolone versus macrolide monotherapy in Legionella pneumonia using a systematic review and meta-analysis. We conducted a systematic search of literature in PubMed, Cochrane, Scopus, and Web of Science from inception to 1 June 2019. Randomized controlled trials and observational studies comparing macrolide with fluoroquinolone monotherapy using clinical outcomes in patients with Legionella pneumonia were included. Twenty-one publications out of an initial 2073 unique records met the selection criteria. Following PRISMA guidelines, 2 reviewers participated in data extraction. The primary outcome was mortality. Secondary outcomes included clinical cure, time to apyrexia, length of hospital stay (LOS), and the occurrence of complications. The review and meta-analysis was registered with PROSPERO (CRD42019132901). Twenty-one publications with 3525 patients met inclusion criteria. The mean age of the population was 60.9 years and 67.2% were men. The mortality rate for patients treated with fluoroquinolones was 6.9% (104/1512) compared with 7.4% (133/1790) among those treated with macrolides. The pooled odds ratio assessing risk of mortality for patients treated with fluoroquinolones versus macrolides was 0.94 (95% confidence interval, .71-1.25, I2 = 0%, P = .661). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ for patients treated with fluoroquinolones versus macrolides. We found no difference in the effectiveness of fluoroquinolones versus macrolides in reducing mortality among patients with Legionella pneumonia.

Sections du résumé

BACKGROUND
The Infectious Diseases Society of America recommends either a fluoroquinolone or a macrolide as a first-line antibiotic treatment for Legionella pneumonia, but it is unclear which antibiotic leads to optimal clinical outcomes. We compared the effectiveness of fluoroquinolone versus macrolide monotherapy in Legionella pneumonia using a systematic review and meta-analysis.
METHODS
We conducted a systematic search of literature in PubMed, Cochrane, Scopus, and Web of Science from inception to 1 June 2019. Randomized controlled trials and observational studies comparing macrolide with fluoroquinolone monotherapy using clinical outcomes in patients with Legionella pneumonia were included. Twenty-one publications out of an initial 2073 unique records met the selection criteria. Following PRISMA guidelines, 2 reviewers participated in data extraction. The primary outcome was mortality. Secondary outcomes included clinical cure, time to apyrexia, length of hospital stay (LOS), and the occurrence of complications. The review and meta-analysis was registered with PROSPERO (CRD42019132901).
RESULTS
Twenty-one publications with 3525 patients met inclusion criteria. The mean age of the population was 60.9 years and 67.2% were men. The mortality rate for patients treated with fluoroquinolones was 6.9% (104/1512) compared with 7.4% (133/1790) among those treated with macrolides. The pooled odds ratio assessing risk of mortality for patients treated with fluoroquinolones versus macrolides was 0.94 (95% confidence interval, .71-1.25, I2 = 0%, P = .661). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ for patients treated with fluoroquinolones versus macrolides.
CONCLUSIONS
We found no difference in the effectiveness of fluoroquinolones versus macrolides in reducing mortality among patients with Legionella pneumonia.

Identifiants

DOI: 10.1093/cid/ciaa441 PMID: 32296816 PMC: PMC8315122
pubmed: 32296816
pii: 5820714
doi: 10.1093/cid/ciaa441
pmc: PMC8315122
doi:

Substances chimiques

Anti-Bacterial Agents 0
Fluoroquinolones 0
Macrolides 0

Types de publication

Journal Article Meta-Analysis Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S. Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1979-1989

Commentaires et corrections

Type : CommentIn

Informations de copyright

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Références

Am J Transplant. 2012 Jan;12(1):250-3
pubmed: 22244124
J Microbiol Immunol Infect. 2018 Jun;51(3):352-358
pubmed: 28094205
Clin Infect Dis. 2005 Mar 15;40(6):794-9
pubmed: 15736010
Clin Infect Dis. 2002 Nov 1;35(9):1039-46
pubmed: 12384836
J Antimicrob Chemother. 1990 Oct;26 Suppl B:129-39
pubmed: 2258340
J Antimicrob Chemother. 2014 Sep;69(9):2354-60
pubmed: 24827889
Syst Rev. 2016 Dec 5;5(1):210
pubmed: 27919275
MMWR Morb Mortal Wkly Rep. 2017 Jun 09;66(22):584-589
pubmed: 28594788
J Antimicrob Chemother. 2017 May 1;72(5):1502-1509
pubmed: 28204479
Intern Med. 2007;46(7):353-7
pubmed: 17409596
N Engl J Med. 1997 Jan 23;336(4):243-50
pubmed: 8995086
Chest. 2005 Sep;128(3):1401-5
pubmed: 16162735
Intensive Care Med. 2002 Jun;28(6):686-91
pubmed: 12107671
J Infect. 2009 Sep;59(3):222-4
pubmed: 19592113
Eur Respir J. 1995 Dec;8(12):1999-2007
pubmed: 8666093
J Epidemiol Community Health. 1998 Jun;52(6):377-84
pubmed: 9764259
J Antimicrob Chemother. 1999 Jun;43(6):747-52
pubmed: 10404312
Clin Infect Dis. 1995 Dec;21 Suppl 3:S265-76
pubmed: 8749675
Clin Infect Dis. 2005 Mar 15;40(6):800-6
pubmed: 15736011
JAMA Netw Open. 2018 Jun 1;1(2):e180230
pubmed: 30646071
Clin Infect Dis. 2015 Jun 1;60(11):e66-79
pubmed: 25722195
Epidemiol Infect. 2012 Nov;140(11):2003-13
pubmed: 22233584
Med Intensiva. 2013 Jun-Jul;37(5):320-6
pubmed: 22854618
J Antimicrob Chemother. 2003 May;51(5):1119-29
pubmed: 12668578
Drug Saf. 2003;26(2):109-20
pubmed: 12534327
J Microbiol Immunol Infect. 2019 Jun;52(3):465-470
pubmed: 28964650
Clin Ther. 2002 Apr;24(4):605-15
pubmed: 12017405
MMWR Morb Mortal Wkly Rep. 2015 Oct 30;64(42):1190-3
pubmed: 26513329
Int J Antimicrob Agents. 2005 Jan;25(1):75-83
pubmed: 15620830
P T. 2014 Mar;39(3):203-5
pubmed: 24790398
Medicine (Baltimore). 2013 Jan;92(1):51-60
pubmed: 23266795
Enferm Infecc Microbiol Clin. 2006 Jun-Jul;24(6):360-4
pubmed: 16792936
Int J Tuberc Lung Dis. 2010 Apr;14(4):495-9
pubmed: 20202309
Am J Med. 2017 Dec;130(12):1449-1457.e9
pubmed: 28739200
Am J Respir Med. 2003;2(3):235-43
pubmed: 14720005
Emerg Infect Dis. 2003 Jun;9(6):730-3
pubmed: 12781017
Clin Microbiol Infect. 2017 Sep;23(9):653-658
pubmed: 28267637
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120
Int J Surg. 2010;8(5):336-41
pubmed: 20171303

Auteurs

Annie S Jasper (AS)

William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.

Jackson S Musuuza (JS)

William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.

Jessica S Tischendorf (JS)

Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.

Vanessa W Stevens (VW)

Informatics, Decision Enhancement, and Analytic Sciences Center of Innovation, Veterans Affairs (VA) Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Shantini D Gamage (SD)

National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA.
Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

Fauzia Osman (F)

Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.

Nasia Safdar (N)

William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.

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Classifications MeSH

questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Are Fluoroquinolones or Macrolides Better for...
questionsmedicales.fr › Infection › Infections communautaires › Are Fluoroquinolones or Macrolides Better for...
questionsmedicales.fr › Composés hétérocycliques › Composés hétérocycliques à cycles fusionnés › Composés hétérobicycliques › Quinoléines › Quinolinone › Fluoroquinolones › Are Fluoroquinolones or Macrolides Better for...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Are Fluoroquinolones or Macrolides Better for...
questionsmedicales.fr › Bactéries › Proteobacteria › Gammaproteobacteria › Legionellaceae › Legionella › Are Fluoroquinolones or Macrolides Better for...
questionsmedicales.fr › Composés polycycliques › Composés macrocycliques › Polycétides › Macrolides › Are Fluoroquinolones or Macrolides Better for...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Are Fluoroquinolones or Macrolides Better for...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Infections de l'appareil respiratoire › Pneumopathie infectieuse › Are Fluoroquinolones or Macrolides Better for...