大环内酯类药物作为β-内酰胺类药物的附加疗法对社区获得性肺炎的疗效：随机对照试验荟萃分析。

IF 2.4 3区医学 Q3 PHARMACOLOGY & PHARMACY

European Journal of Clinical Pharmacology Pub Date : 2025-01-01 Epub Date: 2024-11-18 DOI:10.1007/s00228-024-03775-6

Vitória Martins Prizão, Otavio Cosendey Martins, Beatriz Austregésilo de Athayde de Hollanda Morais, Beatriz Ximenes Mendes, Maria Luiza Rodrigues Defante, Mariana de Moura Souza

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引用次数: 0

摘要

目的：本研究旨在评估在治疗社区获得性肺炎（CAP）时，将大环内酯类药物（MAC）加入到β-内酰胺类药物（BL）单药治疗中是否会带来临床益处，从而证明潜在的弊端或副作用是值得的：我们系统检索了PubMed、Embase和Cochrane上的随机对照试验（RCT），这些试验比较了BL单药治疗与BL和MAC联合治疗在院内治疗CAP中的效果。我们汇总了连续性结果的平均差（MD）和二元性结果的风险比（RR），以及 95% 的置信区间（CI）：6项RCT共2661名参与者（52%接受联合治疗）显示，院内死亡率（RR 0.99; 95% CI 0.78 to 1.25; p = 0.94; I2 = 0%）、90天死亡率（RR 1.03; 95% CI 0.82 to 1.29; p = 0.83; I2 = 13%）或30天死亡率（RR 0.90; 75% CI 0.63 to 1.29; p = 0.58; I2 = 54%）无显著差异。此外，在住院时间（MD 0.51；95% CI - 0.50 至 1.51；P = 0.33；I2 = 63%）或呼吸功能不全（RR 0.63；95% CI 0.29 至 1.35；P = 0.24；I2 = 74%）方面未观察到明显差异。然而，联合疗法明显提高了治疗成功率（RR 1.17; 95% CI 1.04 to 1.32; p = 0.009; I2 = 0%）：我们的研究结果表明，BL + MAC疗法不应用于所有CAP住院患者：CRD42024516383 - 注册数据：03/03/2024.

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Effectiveness of macrolides as add-on therapy to beta-lactams in community-acquired pneumonia: A meta-analysis of randomized controlled trials.

Purpose: This study aims to evaluate whether adding macrolides (MAC) to beta-lactam (BL) monotherapy in the treatment of community-acquired pneumonia (CAP) offers clinical benefits that justify the potential disadvantages or side effects.

Methods: We systematically searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing BL monotherapy to combination therapy with BL and MAC for the in-hospital treatment of CAP. We pooled mean differences (MD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CI).

Results: Six RCTs with 2661 participants (52% receiving combination therapy), revealed no significant difference in in-hospital mortality (RR 0.99; 95% CI 0.78 to 1.25; p = 0.94; I2 = 0%), 90-day mortality (RR 1.03; 95% CI 0.82 to 1.29; p = 0.83; I2 = 13%), or 30-day mortality (RR 0.90; 75% CI 0.63 to 1.29; p = 0.58; I2 = 54%). Additionally, no significant differences were observed in the length of hospital stay (MD 0.51; 95% CI - 0.50 to 1.51; p = 0.33; I2 = 63%) or respiratory insufficiency (RR 0.63; 95% CI 0.29 to 1.35; p = 0.24; I2 = 74%). However, combination therapy significantly improved the treatment success rate (RR 1.17; 95% CI 1.04 to 1.32; p = 0.009; I2 = 0%).

Conclusion: Our findings suggest that BL + MAC therapy should not be used in all cases of hospitalized patients with CAP.

Prospero id: CRD42024516383 - Data of registration: 03/03/2024.

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来源期刊

European Journal of Clinical Pharmacology 医学-药学

CiteScore

5.40

自引率

3.40%

发文量

170

审稿时长

3-8 weeks

期刊介绍： The European Journal of Clinical Pharmacology publishes original papers on all aspects of clinical pharmacology and drug therapy in humans. Manuscripts are welcomed on the following topics: therapeutic trials, pharmacokinetics/pharmacodynamics, pharmacogenetics, drug metabolism, adverse drug reactions, drug interactions, all aspects of drug development, development relating to teaching in clinical pharmacology, pharmacoepidemiology, and matters relating to the rational prescribing and safe use of drugs. Methodological contributions relevant to these topics are also welcomed. Data from animal experiments are accepted only in the context of original data in man reported in the same paper. EJCP will only consider manuscripts describing the frequency of allelic variants in different populations if this information is linked to functional data or new interesting variants. Highly relevant differences in frequency with a major impact in drug therapy for the respective population may be submitted as a letter to the editor. Straightforward phase I pharmacokinetic or pharmacodynamic studies as parts of new drug development will only be considered for publication if the paper involves -a compound that is interesting and new in some basic or fundamental way, or -methods that are original in some basic sense, or -a highly unexpected outcome, or -conclusions that are scientifically novel in some basic or fundamental sense.