Comparison of initial empirical antibiotic regimens in severe community-acquired pneumonia: a network meta-analysis

BackgroundSevere community-acquired pneumonia (SCAP) remains a leading cause of morbidity and mortality worldwide. Identifying the optimal antibiotic regimen for treating SCAP is crucial for improving patient outcomes.MethodsWe searched the PubMed, Embase, and Cochrane Central Register of Controlled Clinical Trials databases to identify studies reporting initial empirical antibiotic regimens in patients with SCAP. We performed a network meta-analysis to compare the relative efficacy of different antibiotic regimens in treating SCAP. The primary outcome was overall mortality. The second outcomes were 30-day mortality and in-hospital mortality.ResultsThis network meta-analysis included 1 randomized clinical trial and 13 observational studies with 8142 patients, categorized into five treatment groups: beta-lactam antibiotics, beta-lactam antibiotics plus doxycycline, beta-lactam antibiotics plus fluoroquinolones, beta-lactam antibiotics plus macrolides, and fluoroquinolones monotherapy. beta-lactam antibiotics plus macrolides was ranked as the most effective treatment (surface under the cumulative ranking curve, 92.0%; mean rank, 1.3). The beta-lactam antibiotics plus macrolides combination significantly reduced overall mortality compared to beta-lactam antibiotics alone (RR, 0.79; 95% CI, 0.64-0.96) and beta-lactam antibiotics plus fluoroquinolones (RR, 0.67; 95% CI, 0.64-0.82).ConclusionOur findings suggest that beta-lactam antibiotics plus macrolides may be the optimal treatment for SCAP. beta-lactam antibiotics monotherapy and beta-lactam antibiotics plus fluoroquinolones should not be recommended due to their inferior outcomes.