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Empiric antibiotics for community-acquired pneumonia in adult patients: a systematic review and a network meta-analysis
Thorax ( IF 10 ) Pub Date : 2021-10-01 , DOI: 10.1136/thoraxjnl-2019-214054
Lara Montes-Andujar 1 , Elena Tinoco 1 , Orville Baez-Pravia 2 , Carlos Martin-Saborido 3, 4 , Pablo Blanco-Schweizer 5 , Carmen Segura 5 , Estefania Prol Silva 5 , Vivivan Reyes 6 , Ana Rodriguez Cobo 1 , Carmen Zurdo 7 , Verónica Angel 1 , Olga Varona 1 , José Valero 1 , Rafael Suarez Del Villar 1 , Guillermo Ortiz 8 , Julio Villanueva 1 , Justo Menéndez 1 , Jesús Blanco 5, 9 , Antoni Torres 10, 11 , Pablo A Cardinal-Fernández 12
Affiliation  

Objective The main aim of this network meta-analysis is to identify the empiric antibiotic (Em-ATB) with the highest probability of being the best (HPBB) in terms of (1) cure rate and (2) mortality rate in hospitalised patients with community acquired pneumonia (CAP) . Method Inclusion criteria: (1) adult patients (>16 years old) diagnosed with CAP that required hospitalisation; (2) randomised to at least two different Em-ATBs, (3) that report cure rate and (4) are written in English or Spanish. Exclusion criteria: (1) ambiguous antibiotics protocol and (2) published exclusively in abstract or letter format. Data sources: Medline, Embase, Cochrane and citation reviews from 1 January 2000 to 31 December 2018. Risk of bias: Cochrane’s tool. Quality of the systematic review (SR): A MeaSurement Tool to Assess systematic Reviews-2. Certainity of the evidence: Grading of Recommendations Assessment, Development and Evaluation. Statistical analyses: frequentist method performed with the ‘netmeta’ library, R package. Results 27 randomised controlled trials (RCTs) from the initial 41 307 screened citations were included. Regarding the risk of bias, more than one quarter of the studies presented low risk and no study presented high risk in all domains. The SR quality is moderate. For cure, two networks were constructed. Thus, two Em-ATBs have the HPBB: cetaroline 600 mg (two times a day) and piperacillin 2000 mg (two times a day). For mortality, three networks were constructed. Thus, three Em-ATBs have the HPBB: ceftriaxone 2000 mg (once a day) plus levofloxacin 500 (two times a day), ertapenem 1000 mg (two times a day) and amikacin 250 mg (two times a day) plus clarithromycin 500 mg (two times a day). The certainity of evidence for each results is moderate. Conclusion For cure rate, ceftaroline and piperaciline are the options with the HPBB. However, for mortality rate, the options are ceftriaxone plus levofloxacin, ertapenem and amikacin plus clarithromycin. It seems necessary to conduct an RCT that compares treatments with the HPBB for each event (cure or mortality) (CRD42017060692). Data are available upon reasonable request.

中文翻译:

成人社区获得性肺炎的经验性抗生素:系统评价和网络荟萃分析

目的 该网络荟萃分析的主要目的是确定在 (1) 治愈率和 (2) 住院患者死亡率方面最有可能成为最佳 (HPBB) 的经验性抗生素 (Em-ATB)社区获得性肺炎(CAP)。方法纳入标准:(1)确诊为CAP需要住院治疗的成年患者(>16岁);(2) 随机分配到至少两种不同的 Em-ATB,(3) 报告治愈率和 (4) 用英语或西班牙语编写。排除标准:(1)不明确的抗生素方案和(2)仅以摘要或信件格式发表。数据来源:Medline、Embase、Cochrane 和 2000 年 1 月 1 日至 2018 年 12 月 31 日的引文审查。偏倚风险:Cochrane 的工具。系统评价 (SR) 的质量:评估系统评价的测量工具-2。证据的确定性:建议评估、制定和评估的分级。统计分析:使用“netmeta”库、R 包执行的常客方法。结果 包括来自最初 41 307 篇筛选引文的 27 项随机对照试验 (RCT)。关于偏倚风险,超过四分之一的研究呈现低风险,没有研究在所有领域呈现高风险。SR 质量适中。为了治愈,构建了两个网络。因此,两种 Em-ATB 具有 HPBB:西塔洛林 600 毫克(一天两次)和哌拉西林 2000 毫克(一天两次)。对于死亡率,构建了三个网络。因此,三个 Em-ATB 具有 HPBB:头孢曲松 2000 mg(每天一次)加左氧氟沙星 500(每天两次),厄他培南 1000 mg(一天两次)和阿米卡星 250 mg(一天两次)加克拉霉素 500 mg(一天两次)。每个结果的证据确定性是中等的。结论 就治愈率而言,头孢洛林和哌拉西林是HPBB的选择。然而,对于死亡率,选择是头孢曲松加左氧氟沙星、厄他培南和阿米卡星加克拉霉素。似乎有必要进行 RCT,比较每个事件(治愈或死亡)的治疗与 HPBB (CRD42017060692)。可根据合理要求提供数据。似乎有必要进行 RCT,比较每个事件(治愈或死亡)的治疗与 HPBB (CRD42017060692)。可根据合理要求提供数据。似乎有必要进行 RCT,比较每个事件(治愈或死亡)的治疗与 HPBB (CRD42017060692)。可根据合理要求提供数据。
更新日期:2021-09-17
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