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Meta-Analysis
. 2021 Jun 1;72(11):1979-1989.
doi: 10.1093/cid/ciaa441.

Are Fluoroquinolones or Macrolides Better for Treating Legionella Pneumonia? A Systematic Review and Meta-analysis

Annie S Jasper  1   2 , Jackson S Musuuza  1   2 , Jessica S Tischendorf  2 , Vanessa W Stevens  3   4 , Shantini D Gamage  5   6 , Fauzia Osman  2 , Nasia Safdar  1   2
Affiliations
Meta-Analysis

Are Fluoroquinolones or Macrolides Better for Treating Legionella Pneumonia? A Systematic Review and Meta-analysis

Annie S Jasper et al. Clin Infect Dis. .

Abstract

Background: The Infectious Diseases Society of America recommends either a fluoroquinolone or a macrolide as a first-line antibiotic treatment for Legionella pneumonia, but it is unclear which antibiotic leads to optimal clinical outcomes. We compared the effectiveness of fluoroquinolone versus macrolide monotherapy in Legionella pneumonia using a systematic review and meta-analysis.

Methods: We conducted a systematic search of literature in PubMed, Cochrane, Scopus, and Web of Science from inception to 1 June 2019. Randomized controlled trials and observational studies comparing macrolide with fluoroquinolone monotherapy using clinical outcomes in patients with Legionella pneumonia were included. Twenty-one publications out of an initial 2073 unique records met the selection criteria. Following PRISMA guidelines, 2 reviewers participated in data extraction. The primary outcome was mortality. Secondary outcomes included clinical cure, time to apyrexia, length of hospital stay (LOS), and the occurrence of complications. The review and meta-analysis was registered with PROSPERO (CRD42019132901).

Results: Twenty-one publications with 3525 patients met inclusion criteria. The mean age of the population was 60.9 years and 67.2% were men. The mortality rate for patients treated with fluoroquinolones was 6.9% (104/1512) compared with 7.4% (133/1790) among those treated with macrolides. The pooled odds ratio assessing risk of mortality for patients treated with fluoroquinolones versus macrolides was 0.94 (95% confidence interval, .71-1.25, I2 = 0%, P = .661). Clinical cure, time to apyrexia, LOS, and the occurrence of complications did not differ for patients treated with fluoroquinolones versus macrolides.

Conclusions: We found no difference in the effectiveness of fluoroquinolones versus macrolides in reducing mortality among patients with Legionella pneumonia.

Keywords: Legionella pneumonia; Legionnaire’s disease; fluoroquinolones; macrolides.

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Figures

Figure 1.
Figure 1.
Summary of evidence search and study selection. Abbreviation: RCT, randomized controlled trial.
Figure 2.
Figure 2.
Forest plot for comparison of fluoroquinolone and macrolide effectiveness in treating Legionella pneumonia: analysis of mortality. Abbreviations: CI, confidence interval; ICU, intensive care unit; OR, odds ratio.
Figure 3.
Figure 3.
Forest plot for comparison of mortality following treatment of Legionella pneumonia with fluoroquinolone versus macrolides among ICU patients. Abbreviations: CI, confidence interval; ICU, intensive care unit; OR, odds ratio.
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References

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