Q&A

Antibiotic choice makes little difference in CAP

J Fam Pract. 2005 June;54(6):493-500
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  • Clinical Question: In the treatment of patients with community-acquired pneumonia, is there a difference among antibiotics?
  • Study Design: Meta-analysis (randomized controlled trials)
  • Setting: Various (meta-analysis)
  • Synopsis: We have to treat some patients with community-acquired pneumonia (CAP) for atypical bacteria, just in case, don’t we? This question was answered by the authors of this meta-analysis. They identified 18 studies comparing a beta-lactam antibiotic with an antibiotic active against the atypical pathogens M pneumoniae, Legionella species, and C pneumoniae: macrolides, fluoroquinolones, or ketolides (eg, telithromycin [Ketek]). They used rigorous methods to identify the studies, searching 3 databases for articles published in any language, searching the reference lists of review articles and retrieved studies, and including unpublished research conducted by pharmaceutical companies. Two reviewers independently screened the studies for inclusion. On average, the 6749 patients in the clinical trials were younger than the typical patient with pneumonia (in most studies the average age was between 40 and 55 years) and had a better risk profile.
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Bottom Line

Strange, but true: Oral beta-lactam antibiotics— amoxicillin, amoxicillin/clavulanate (Augmentin), or a cephalosporin—are as effective in the treatment of community-acquired pneumonia as antibiotics active against atypical pathogens, even in patients infected with Mycoplasma pneumoniae or Chlamydia pneumoniae. These old standbys can be used instead of the more expensive drugs for most patients.

Legionella infection still requires treatment with an antibiotic effective against atypical pathogens, but in these studies only 1.1% of the patients with nonsevere pneumonia had Legionella. These results are backed up by similar findings from clinical practice (Hedlund J, et al. Scand J Infect Dis 2002; 34:887–892). (LOE=1a)

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