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

Vardakas, Konstantinos Z.; Siempos, Ilias I.; Grammatikos, Alexandros; Athanassa, Zoe; Korbila, Ioanna P.; Falagas, Matthew E.
December 2008
CMAJ: Canadian Medical Association Journal;12/2/2008, Vol. 179 Issue 12, p1269
Academic Journal
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).


Related Articles

  • Early switch therapy from intravenous sulbactam/ampicillin to oral garenoxacin in patients with community-acquired pneumonia: a multicenter, randomized study in Japan. Kohno, Shigeru; Yanagihara, Katsunori; Yamamoto, Yoshihiro; Tokimatsu, Issei; Hiramatsu, Kazufumi; Higa, Futoshi; Tateyama, Masao; Fujita, Jiro; Kadota, Jun-ichi // Journal of Infection & Chemotherapy (Springer Science & Business;Dec2013, Vol. 19 Issue 6, p1035 

    The switch from intravenous to oral antibiotic therapy is recommended for treating hospitalized patients with community-acquired pneumonia (CAP). We performed a multicenter, randomized study to assess the benefit of switching from intravenous sulbactam/ampicillin (SBT/ABPC) to oral garenoxacin...

  • Preface. Johnson, Alan P.; Leibovici, Leonard // Journal of Antimicrobial Chemotherapy (JAC);Apr2011 Supplement 3, Vol. 66 Issue suppl_3, piii1 

    The article introduces a series of reports on the efficacy and safety of ceftaroline fosamil based on two randomized controlled trials of community-associated pneumonia (CAP), published within the issue.

  • Study conclusions should reflect results. Morris, Andrew M.; Vardakas, Konstantinos Z.; Siempos, Ilias I.; Falagas, Matthew E. // CMAJ: Canadian Medical Association Journal;3/31/2009, Vol. 180 Issue 7, p738 

    A letter to the editor in response to the article "Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials," in the 2008 issue, as well as the authors' response is presented.

  • Early Switch to Oral Treatment in Patients with Moderate to Severe Community-Acquired Pneumonia: A Meta-Analysis. Athanassa, Zoe; Makris, Gregory; Dimopoulos, George; Falagas, Matthew E. // Drugs;2008, Vol. 68 Issue 17, p2469 

    Background: Early switch to oral antibacterials is recommended for the treatment of hospitalized patients with community-acquired pneumonia (CAP). However, its efficacy and safety in patients with more severe forms of CAP have not been well established. Objective: To evaluate early switch to...

  • FOCUS 1: a randomized, double-blinded, multicentre, Phase III trial of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in community-acquired pneumonia. File Jr, Thomas M.; Low, Donald E.; Eckburg, Paul B.; Talbot, George H.; Friedland, H. David; Lee, Jon; Llorens, Lily; Critchley, Ian A.; Thye, Dirk A. // Journal of Antimicrobial Chemotherapy (JAC);Apr2011 Supplement 3, Vol. 66 Issue suppl_3, piii19 

    Objectives Ceftaroline, the active form of the prodrug ceftaroline fosamil, is a novel cephalosporin with bactericidal activity against important pathogens associated with community-acquired pneumonia (CAP), including Streptococcus pneumoniae and common Gram-negative pathogens. FOCUS 1 is a...

  • A Multi-Center Randomised Controlled Trial of Gatifloxacin versus Azithromycin for the Treatment of Uncomplicated Typhoid Fever in Children and Adults in Vietnam. Dolecek, Christiane; Tran Thi Phi La; Nguyen Ngoc Rang; Le Thi Phuong; Ha Vinh; Phung Quoc Tuan; Doan Cong Du; Nguyen Thi Be Bay; Duong Thanh Long; Luong Bich Ha; Nguyen Trung Binh; Nguyen Thi Anh Hong; Pham Ngoc Dung; Mai Ngoc Lanh; Phan Van Be Bay; Vo Anh Ho; Nguyen Van Minh Hoang; Tran Thu Thi Nga; Tran Thuy Chau; Schultsz, Constance // PLoS Clinical Trials;May2008, Vol. 5 Issue 5, Special section p1 

    Background: Drug resistant typhoid fever is a major clinical problem globally. Many of the first line antibiotics, including the older generation fluoroquinolones, ciprofloxacin and ofloxacin, are failing. Objectives: We performed a randomised controlled trial to compare the efficacy and safety...

  • Clinical and bacteriological efficacies of sitafloxacin against community-acquired pneumonia caused by Streptococcus pneumoniae: nested cohort within a multicenter clinical trial. Fujita, Jiro; Niki, Yoshihito; Kadota, Jun-ichi; Yanagihara, Katsunori; Kaku, Mitsuo; Watanabe, Akira; Aoki, Nobuki; Hori, Seiji; Tanigawara, Yusuke; Cash, Haley; Kohno, Shigeru // Journal of Infection & Chemotherapy (Springer Science & Business;Jun2013, Vol. 19 Issue 3, p472 

    We evaluated the clinical and bacteriological efficacy of oral sitafloxacin (STFX) in clinically diagnosed community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae. Additionally, we cultured these patient samples to test the minimal inhibitory concentrations (MICs) of levofloxacin...

  • Efficacy of levofloxacin-based rescue therapy for Helicobacter pylori infection after standard triple therapy: a randomized controlled trial. Kuo, Chao-Hung; Hu, Huang-Ming; Kuo, Fu-Chen; Hsu, Ping-I.; Chen, Angela; Yu, Fang-Jung; Tsai, Pei-Yun; Wu, I.-Chen; Wang, Sheng-Wen; Li, Chia-Jung; Weng, Bi-Chuang; Chang, Lin-Li; Jan, Chang-Ming; Wang, Wen-Ming; Wu, Deng-Chyang // Journal of Antimicrobial Chemotherapy (JAC);May2009, Vol. 63 Issue 5, p1017 

    : Objectives This prospective study was designed to determine the efficacy of a levofloxacin-based rescue therapy for Helicobacter pylori infection after failure of standard triple therapies. We also surveyed the predictors of this rescue therapy. : Patients and methods From June 2005 to March...

  • Levofloxacin reduces LOS and costs in CAP.  // PharmacoEconomics & Outcomes News;3/22/2008, Issue 549, p5 

    The article discusses research on the hospital length of stay (LOS) of patients with community-acquired pneumonia (CAP) being treated with levofloxacin. It references a study by J. Schein and colleagues published in the March 2008 issue of "Current Medical Research and Opinion." Inpatient...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics