β-Lactam/macrolide dual therapy versus β-lactam monotherapy for the treatment of community-acquired pneumonia in adults: a systematic review and meta-analysis

Several studies have compared the clinical effect of beta-lactam/macrolide (BLM) dual therapy versus beta-lactam (BL) monotherapy in community-acquired pneumonia (CAP) patients. However, the results remain controversial. Thus, we did this meta-analysis to determine which treatment was more effective. Databases comprising PubMed, Embase and the Cochrane Register of Controlled Trials were searched to find relevant studies. The primary outcome was mortality. The Newcastle-Ottawa scale was used to evaluate the methodological quality of included studies. Multivariable-adjusted ORs with 95% CIs were pooled in the random effects model. Four prospective cohort studies and 12 retrospective cohort studies were included (naEuroS=aEuroS42aEuroS942). Compared with BL monotherapy, BLM dual therapy was significantly associated with reduced mortality (adjusted OR 0.67, 95% CI 0.61-0.73, PaEuroS < aEuroS0.001, I(2)aEuroS=aEuroS3%). Subsequent subgroup analyses confirmed that BLM dual therapy was statistically superior to BL monotherapy in reduction of mortality. Sensitivity analyses strengthened the validity of the results. In comparison with BL monotherapy, BLM dual therapy might reduce mortality risk in patients with CAP. Because this finding is based on observational studies, randomized controlled trials are required to demonstrate the usefulness of BLM dual therapy in the treatment of CAP.