Effectiveness of β lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia:: meta-analysis
Effectiveness of β lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia:: meta-analysis
复制标题
DOI：
10.1136/bmj.38334.591586.82
复制
发表时间：
2005-02-26
影响因子：
105.7
通讯作者：
Arrol, B
中科院分区：
文献类型：
--
作者：
Mills, GD;Oehley, MR;Arrol, B
目的系统比较β-内酰胺类抗生素和抗非典型病原体抗生素在社区获得性肺炎治疗中的作用。资料来源：Medline、Embase、Cochrane对照试验登记、国际会议记录、药品注册机构和制药公司。结果18项试验共6749名参与者，大多数患者患有轻中度社区获得性肺炎。在所有原因的社区获得性肺炎中，治疗失败的总体相对风险显示，抗非典型病原菌的抗生素与内酰胺类抗生素相比没有优势(0.97，95%可信区间0.87至1.07)。亚组分析是在那些具有涉及非典型病原体的特定诊断的人中进行的。我们发现，军团菌患者使用对非典型病原体有效的抗生素治疗的失败率显著较低(0.40，0.19至0.85)。肺炎支原体(0.60，0.31~1.17)和肺炎衣原体(2.32，0.67~8.03)与肺炎支原体(0.60，0.31~1.17)相当。结论在所有非重症社区获得性肺炎中，使用抗非典型病原体有效的抗生素可改善临床预后，缺乏证据。虽然这种抗生素在治疗后来被证明患有军团菌相关性肺炎的患者方面更好，但在纳入的试验中，这种病原体很少导致肺炎。对于患有非严重社区获得性肺炎的成年人，β-内酰胺类药物仍应是首选抗生素。
Objective To systematically compare beta lactam antibiotics with antibiotics active against atypical pathogens in the management of community acquired pneumonia.Data sources Medline, Embase, Cochrane register of controlled trials, international conference proceedings, drug registration authorities, and pharmaceutical companies.Review methods Double blind randomised controlled monotherapy trials comparing beta lactam antibiotics with antibiotics active against atypical pathogens in adults with community acquired pneumonia. Primary outcome was failure to achieve clinical cure or improvement.Results 18 trials totalling 6749 participants were identified, with most patients having mild to moderate community acquired pneumonia. The summary relative risk for treatment failure in all cause community acquired pneumonia showed no advantage of antibiotics active against atypical pathogens over P lactam antibiotics (0.97,95% confidence interval 0.87 to 1.07). Subgroup analysis was undertaken in those with a specific diagnosis involving atypical pathogens. We found a significantly lower failure rate in patients with Legionella species who were treated with antibiotics active against atypical pathogens (0.40, 0.19 to 0.85). Equivalence was seen for Mycoplasma pneumoniae (0.60, 0.31 to 1.17) and Chlamydia pneumoniae (2.32, 0.67 to 8.03).Conclusions Evidence is lacking that clinical outcomes are improved by using antibiotics active against atypical pathogens in all cause non-severe community acquired pneumonia. Although such antibiotics were superior in the management of patients later shown to have legionella related pneumonia, this pathogen was rarely responsible for pneumonia within the included trials. beta lactam agents should remain the antibiotics of initial choice in adults with non-severe community acquired pneumonia.