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Quinolones show the strongest trends for better clinical response and lower mortality in adults with mild-to-moderate community-acquired pneumonia, though no antibiotic proves clearly superior.
A network meta-analysis has examined how different empiric oral antibiotic regimens perform in adults with mild-to-moderate community-acquired pneumonia (CAP), highlighting differences in clinical response and mortality but stopping short of identifying a clearly superior option. Researchers systematically reviewed PubMed, the Cochrane Library, and reference lists of clinical guidelines and prior systematic reviews to identify randomized trials involving adults with radiologically confirmed mild-to-moderate CAP.
Eligible studies included those who received initial oral antibiotic therapy and reported outcomes on clinical cure or mortality. Data were abstracted in parallel, and both antibiotic-specific and class-based analyses were performed. Results were displayed via network diagrams and forest plots, with rankings assessed by p-scores. Research quality was evaluated via the Cochrane Risk of Bias framework, alongside assessments of both local and global inconsistency. The review included 24 randomized trials involving 9,361 patients. Of these, 6 were deemed low risk of bias, 6 unclear, and 12 high risk.
Key findings
1. Clinical response
2. Mortality outcomes
3. By antibiotic class
Despite these trends, the authors noted that the confidence intervals were wide and overlapping, limiting certainty about any one regimen’s superiority. To sum up, quinolones may yield advantages in both clinical cure rates and mortality outcomes for empiric treatment of mild-to-moderate CAP. However, no antibiotic emerged as definitively more beneficial than the rest. The authors emphasize the requisition for further large-scale, high-quality trials to guide evidence-based recommendations in outpatient pneumonia care.
Journal of General Internal Medicine
Identifying the Best Initial Oral Antibiotics for Adults with Community-Acquired Pneumonia: A Network Meta-Analysis
Peter K Kurotschka et al.
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