Work

Comparison of initial empirical antibiotic regimens in severe community-acquired pneumonia: a network meta-analysis

Year: 2025

Type: article

Study designs: Systematic Review, Meta-Analysis

Abstract: BACKGROUND: Severe community-acquired pneumonia (SCAP) remains a leading cause of morbidity and mortality worldwide. Identifying the optimal antibiotic regimen for treating SCAP is crucial for improving patient outcomes. METHODS: We searched the PubMed, Embase, and Cochrane Central Register of Controlled Clinical Trials databases to identify studies reporting initial empirical antibiotic regimens in patients with SCAP. We performed a network meta-analysis to compare the relative efficacy of different antibiotic regimens in treating SCAP. The primary outcome was overall mortality. The second outcomes were 30-day mortality and in-hospital mortality. RESULTS: This network meta-analysis included 1 randomized clinical trial and 13 observational studies with 8142 patients, categorized into five treatment groups: β-lactam antibiotics, β-lactam antibiotics plus doxycycline, β-lactam antibiotics plus fluoroquinolones, β-lactam antibiotics plus macrolides, and fluoroquinolones monotherapy. β-lactam antibiotics plus macrolides was ranked as the most effective treatment (surface under the cumulative ranking curve, 92.0%; mean rank, 1.3). The β-lactam antibiotics plus macrolides combination significantly reduced overall mortality compared to β-lactam antibiotics alone (RR, 0.79; 95% CI, 0.64-0.96) and β-lactam antibiotics plus fluoroquinolones (RR, 0.67; 95% CI, 0.64-0.82). CONCLUSION: Our findings suggest that β-lactam antibiotics plus macrolides may be the optimal treatment for SCAP. β-lactam antibiotics monotherapy and β-lactam antibiotics plus fluoroquinolones should not be recommended due to their inferior outcomes.

Source: BMC Pulmonary Medicine

DOI: 10.1186/s12890-025-03695-w