Macrolides for better resolution of community-acquired pneumonia: A global meta-analysis of clinical outcomes with focus on microbial aetiology

Miltiades Kyprianou, Konstantina Dakou, Aftab Aktar, Hichem Aouina, Naser Behbehani, Keertan Dheda, Georges Juvelekian, Adel Khattab, Bassam Mahboub, George Nyale, Sayed Oraby, Abdullah Sayiner, Atef Shibl, Mohamed Awad Tag El Deen, Serhat Unal, Ali Bin Sarwar Zubairi, Ross Davidson, Evangelos J. Giamarellos-Bourboulis

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Objectives: This meta-analysis examined the effect of macrolides on resolution of community-acquired pneumonia (CAP) and interpretation of clinical benefit according to microbiology; emphasis is given to data under-reported countries (URCs). Methods: This meta-analysis included 47 publications published between 1994 and 2022. Publications were analysed for 30-d mortality (58 759 patients) and resolution of CAP (6465 patients). A separate meta-analysis was done for the prevalence of respiratory pathogens in URCs. Results: Mortality after 30 d was reduced by the addition of macrolides (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.51–0.82). The OR for CAP resolution when macrolides were added to the treatment regimen was 1.23 (95% CI 1.00–1.52). In the CAP resolution analysis, the most prevalent pathogen was Streptococcus pneumoniae (12.68%; 95% CI 9.36–16.95%). Analysis of the pathogen epidemiology from the URCs included 12 publications. The most prevalent pathogens were S. pneumoniae (24.91%) and Klebsiella pneumoniae (12.90%). Conclusion: The addition of macrolides to the treatment regimen led to 35% relative decrease of 30-d mortality and to 23% relative increase in resolution of CAP.

Original languageEnglish
Article number106942
JournalInternational Journal of Antimicrobial Agents
Volume62
Issue number4
DOIs
Publication statusPublished - Oct 2023

Keywords

  • Community-acquired pneumonia
  • Klebsiella pneumoniae
  • Macrolides
  • Microbiology
  • Streptococcus pneumoniae
  • Underreported countries

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