Macrolides vs. quinolones for community-acquired pneumonia: Meta-analysis of randomized controlled trials Clinical Microbiology and Infection, 03/26/2012

Skalsky K et al. – Randomized controlled trials show an advantage to quinolones in the treatment of CAP with regard to clinical cure without need for antibiotic modification at end of treatment and gastrointestinal adverse events. The clinical significance of this advantage is unclear.

• Sixteen trials (4989 patients) fulfilling inclusion criteria were identified, mostly assessing outpatients with mild to moderate CAP.

• All–cause mortality was not significantly different for macrolides vs. quinolones, RR 1.03 (0.63–1.68, 7 trials), with a low event rate (2%).
• Treatment failure was significantly lower with quinolones, RR 0.78 (0.67–0.91, 16 trials).
• The definition of failure used in the primary studies was not clearly representative of patients’ benefit.
• Microbiological failure was lower with quinolones, RR 0.63, (0.49–0.81, 13 trials).
• All adverse events, adverse events requiring discontinuation and any premature antibiotic discontinuation were significantly more frequent with macrolides, mainly on account of gastrointestinal adverse events.
• Resistance development was not assessed in the trials.