The outcome difference of monotherapy versus combination therapy among patients with pneumonia: a systematic review.

Abstract

Introduction: Pneumonia is a severe public health problem on a global scale. Pneumonia continues to be the leading infectious disease-related cause of mortality worldwide. Selecting appropriate antimicrobial treatment is a significant challenge including multi-drug resistant bacteria. The use of monotherapy and combination therapy of antibiotics in pneumonia is still controversial. Considering the wide range of patient characteristics and illness severity in pneumonia, it is important to investigate the variables that affect mortality in different treatment plans. Therefore, this study aimed to systematically review the available evidence regarding comparing monotherapy and combination regimens in pneumonia patients.

Evidence acquisition: A systematic search across various electronic databases like PubMed, Google Scholar, Proquest, and Cochrane was conducted to identify articles published from 2014 to 2024. Review papers, incomplete articles, and duplicates were excluded.

Evidence synthesis: Initially, 179 articles were retrieved from the database search. After a systematic elimination process, sox pertinent articles were identified. These articles involved a total of 11,513 patients across 11 studies. All studies were conducted at single centers, comprising three retrospective cohort studies, one prospective cohort study, one randomized controlled trial, and one cross-sectional study.

Conclusions: Monotherapy and combination therapy have comparable outcomes in mortality rate and hospital length of stay. However, combination therapy is linked with a lower mortality rate in immunocompromised and APACHE ≥15 patients.