Antibacterial class not obviously important in outpatient pneumonia: a meta-analysis

Purpose: To systematically compare outcomes between antibiotic classes in treating outpatient community-acquired pneumonia, regarding antibacterials active against atypical organisms, or various antibacterial classes with similar atypical coverage. Methods: Meta-analysis of randomized control trials of antibacterials for community-acquired pneumonia in outpatients at least 18 years old. Studies were independently reviewed two reviewers. We compared clinical success and mortality between different oral antibiotic classes and specifically compared antibacterials with atypical coverage (macrolides and fluoroquinolones) with others. Results: Thirteen eligible studies involving 4,314 total patients were included. The quality of the studies was variable. Five studied macrolides and fluoroquinolones, three studied macrolides and beta-lactams, three studied fluoroquinolones and beta-lactams, and two studied cephalosporins versus beta lactams/ beta-lactamase inhibitors. There was no significant difference detected regarding clinical success or mortality regardless of atypical coverage, or between antibacterial classes with similar atypical coverage. Conclusions: We could not demonstrate any advantage of specific antibacterials for mild communityacquired pneumonia in relatively healthy outpatients. The need for coverage of atypical pathogens in this setting is not apparent. In mild to moderate cases of outpatient-treated, community-acquired pneumonia, selecting antibacterials might be most appropriate according to side effects, patient preferences, availability, and cost.