• Lee Jong Hoo JH http://orcid.org/0000-0003-2626-7099 Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea., Kim Hyun Jung HJ http://orcid.org/0000-0003-2018-2385 Institute for Evidence-based Medicine, Department of Preventive Medicine, Korea University Colle, and Yee Hyung Kim.
• Department of Internal Medicine, Jeju National University Hospital, Jeju, Korea.
• J. Korean Med. Sci. 2017 Jan 1; 32 (1): 77-84.

AbstractAdding either macrolide or fluoroquinolone (FQ) to β-lactam has been recommended for patients with severe community-acquired pneumonia (CAP). However, due to the limited evidence available, there is a question as to the superiority of the two combination therapies. The MEDLINE, EMBASE, Cochrane Central Register, Scopus, and Web of Science databases were searched for systematic review and meta-analysis. A total of eight trials were analyzed. The total number of patients in the β-lactam plus macrolide (BL-M) and β-lactam plus fluoroquinolone (BL-F) groups was 2,273 and 1,600, respectively. Overall mortality of the BL-M group was lower than that of the BL-F group (19.4% vs. 26.8%), which showed statistical significance (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.49 to 0.94; P = 0.02). Length of hospital stay was reduced in the BL-M group compared to the BL-F group (mean difference, -3.05 days; 95% CI, -6.01 to -0.09; P = 0.04). However, there was no significant difference in length of intensive care unit (ICU) stay between the two groups. Among patients with severe CAP, BL-M therapy may better reduce overall mortality and length of hospital stay than BL-F therapy. However, we could not elicit strong conclusions from the available trials due to high risk of bias and methodological limitations.

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