RT Journal Article
SR Electronic
T1 Empiric antibiotics for community-acquired pneumonia in adult patients: a systematic review and a network meta-analysis
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 1020
OP 1031
DO 10.1136/thoraxjnl-2019-214054
VO 76
IS 10
A1 Lara Montes-Andujar
A1 Elena Tinoco
A1 Orville Baez-Pravia
A1 Carlos Martin-Saborido
A1 Pablo Blanco-Schweizer
A1 Carmen Segura
A1 Estefania Prol Silva
A1 Vivivan Reyes
A1 Ana Rodriguez Cobo
A1 Carmen Zurdo
A1 Verónica Angel
A1 Olga Varona
A1 José Valero
A1 Rafael Suarez del Villar
A1 Guillermo Ortiz
A1 Julio Villanueva
A1 Justo Menéndez
A1 Jesús Blanco
A1 Antoni Torres
A1 Pablo A Cardinal-Fernández
YR 2021
UL http://thorax.bmj.com/content/76/10/1020.abstract
AB Objective The main aim of this network meta-analysis is to identify the empiric antibiotic (Em-ATB) with the highest probability of being the best (HPBB) in terms of (1) cure rate and (2) mortality rate in hospitalised patients with community acquired pneumonia (CAP) .Method Inclusion criteria: (1) adult patients (>16 years old) diagnosed with CAP that required hospitalisation; (2) randomised to at least two different Em-ATBs, (3) that report cure rate and (4) are written in English or Spanish. Exclusion criteria: (1) ambiguous antibiotics protocol and (2) published exclusively in abstract or letter format. Data sources: Medline, Embase, Cochrane and citation reviews from 1 January 2000 to 31 December 2018. Risk of bias: Cochrane’s tool. Quality of the systematic review (SR): A MeaSurement Tool to Assess systematic Reviews-2. Certainity of the evidence: Grading of Recommendations Assessment, Development and Evaluation. Statistical analyses: frequentist method performed with the ‘netmeta’ library, R package.Results 27 randomised controlled trials (RCTs) from the initial 41 307 screened citations were included. Regarding the risk of bias, more than one quarter of the studies presented low risk and no study presented high risk in all domains. The SR quality is moderate. For cure, two networks were constructed. Thus, two Em-ATBs have the HPBB: cetaroline 600 mg (two times a day) and piperacillin 2000 mg (two times a day). For mortality, three networks were constructed. Thus, three Em-ATBs have the HPBB: ceftriaxone 2000 mg (once a day) plus levofloxacin 500 (two times a day), ertapenem 1000 mg (two times a day) and amikacin 250 mg (two times a day) plus clarithromycin 500 mg (two times a day). The certainity of evidence for each results is moderate.Conclusion For cure rate, ceftaroline and piperaciline are the options with the HPBB. However, for mortality rate, the options are ceftriaxone plus levofloxacin, ertapenem and amikacin plus clarithromycin. It seems necessary to conduct an RCT that compares treatments with the HPBB for each event (cure or mortality) (CRD42017060692).Data are available upon reasonable request.