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Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials

From the Alfa Institute of Biomedical Sciences (Vardakas, Siempos, Grammatikos, Athanassa, Korbila, Falagas), Athens, Greece; and Tufts University School of Medicine (Falagas), Boston, USA

Correspondence to: Dr. Matthew E. Falagas, 9 Neapoleos St., 151 23 Marousi, Greece; fax 30-210-68 39 605; m.falagas{at}aibs.gr

Background: We investigated whether the use of respiratory fluoroquinolones was associated with better clinical outcomes compared with the use of macrolides and β- lactams among adults with pneumonia.

Methods: We searched PubMed, Current Contents, Scopus, EMBASE, ClinicalTrials.gov and Cochrane with no language restrictions. Two reviewers independently extracted data from published trials that compared fluoroquinolones (levofloxacin, moxifloxacin, gemifloxacin) with macrolides or β-lactams or both. A meta-analysis was performed with the clinical outcomes of mortality, treatment success and adverse outcomes.

Results: We included 23 trials in our meta-analysis. There was no difference in mortality among patients who received fluoroquinolones or the comparator antibiotics (OR 0.85, 95% CI 0.65–1.12). Pneumonia resolved in more patients who received fluoroquinolones compared with the comparator antibiotics for the included outcomes in the intention-to-treat population (OR 1.17, 95% CI 1.00–1.36), clinically evaluable population (OR 1.26, 95% CI 1.06–1.50) and the microbiologically assessed population (OR 1.67, 95% CI 1.28–2.20). Fluoroquinolones were more effective than a combination of β-lactam and macrolide (OR 1.39, 95% CI 1.02–1.90). They were also more effective for patients with severe pneumonia (OR 1.84, 95% CI 1.02–3.29), those who required admission to hospital (OR = 1.30, 95% CI 1.04–1.61) and those who required intravenous therapy (OR = 1.44, 15% CI 1.13–1.85). Fluoroquinolones were more effective than β-lactam and macrolide in open-label trials (OR = 1.35, 95% CI 1.08–1.69) but not in blinded randomized controlled trials (OR = 1.13, 95% CI 0.85–1.50).

Interpretation: Fluoroquinolones were associated with higher success of treatment for severe forms of pneumonia; however, a benefit in mortality was not evident. A randomized controlled trial that includes patients with severe pneumonia with or without bacteremia is needed.

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				A. M. Morris Study conclusions should reflect results Can. Med. Assoc. J., March 31, 2009; 180(7): 738 - 738. [Full Text] [PDF]

				K. Z. Vardakas, I. I. Siempos, and M. E. Falagas Study conclusions should reflect results Can. Med. Assoc. J., March 31, 2009; 180(7): 738 - 738. [Full Text] [PDF]

				D. E. Low MD Treatment of community-acquired pneumonia Can. Med. Assoc. J., December 2, 2008; 179(12): 1245 - 1246. [Full Text] [PDF]

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