Are Fluoroquinolones or Macrolides Better for Treating Legionella Pneumonia? A Systematic Review and Meta-analysis.
Clin Infect Dis. 2020 Apr 16;:
Authors: Jasper AS, Musuuza JS, Tischendorf JS, Stevens VW, Gamage SD, Osman F, Safdar N
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 compare 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 June 1, 2019. Randomized controlled trials and observational studies comparing macrolide vs. fluoroquinolone monotherapy using clinical outcomes in patients with Legionella pneumonia were included. Twenty-one publications out of an initial 2,073 unique records met the selection criteria. Following PRISMA guidelines, two 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.
RESULTS: Twenty-one publications with 3,525 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 to 7.4% (133/1790) among those treated with macrolides. The pooled OR assessing risk of mortality for patients treated with fluoroquinolones vs macrolides was 0.94 (95% CI 0.71-1.25, I2=0%, p= 0.661). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ for patients treated with fluoroquinolones vs. macrolides.
CONCLUSIONS: We found no difference in the effectiveness of fluoroquinolones vs. macrolides in reducing mortality among patients with Legionella pneumonia.Systematic Review Registration number: (PROSPERO: CRD42019132901).
PMID: 32296816 [PubMed - as supplied by publisher]