Efficacy of empiric macrolides versus fluoroquinolones in community-acquired pneumonia associated with atypical bacteria: A meta-analysis

It is unclear if one empiric regimen for community-acquired pneumonia (CAP) associated with atypical bacteria is superior to another. The objective of this meta-analysis was to compare fluoroquinolones to macrolides in the rates of clinical failure in CAP associated with atypical pathogens.We searched PubMed and EMBASE databases for randomized controlled trials (RCTs) comparing the clinical efficacy of fluoroquinolones with macrolides for CAP associated with atypical bacteria. We estimated risk differences (RRs) with 95% confidence intervals (CIs) using random-effects models and assessed for heterogeneity (I2).Five RCTs met the inclusion criteria. No significant differences between macrolides and fluoroquinolones and were identified in rates of clinical failure in CAP associated with any atypical bacteria (RR = 1.57 [95% CI 0.73 to 3.38]; p = 0.251; I2 = 0%), Chlamydia pneumoniae (RR = 2.12 [95% CI 0.63 to 7.14]; p = 0.223; I2 = 0%), Mycoplasma pneumoniae (RR = 1.28 [95% CI 0.57 to 2.92]; p = 0.550; I2 = 0%), or Legionella pneumophila (RR = 0.24 [95% CI 0.02 to 2.86]; p = 0.256; I2 = 0%).This meta-analysis of RCTs found no significant differences between macrolides and fluoroquinolones in rates of clinical failure in CAP associated with atypical bacteria.