نقش آنتیبیوتیکها در درمان پنومونی اکتسابی از جامعه در بزرگسالان بخش سرپایی
Appendices
Appendix 1. Details of previous search
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2009, issue 1), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register; MEDLINE (January 1966 to February week 2, 2009) and EMBASE (January 1974 to February 2009).
MEDLINE and CENTRAL were searched using the search strategy shown below. We combined the MEDLINE search string with the Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity‐maximising version (2008 revision) (Lefebvre 2011). The search string was adapted for EMBASE, as shown in Appendix 2.
MEDLINE (Ovid)
1 exp Anti‐Bacterial Agents/
2 antibiotic$.mp.
3 or/1‐2
4 exp Pneumonia/
5 exp Community‐Acquired Infections/
6 and/4‐5 (3356)
7 community acquired pneumonia.mp.
8 or/6‐7
9 3 and 8
EMBASE (Elsevier)
#1. 'antibiotic agent'/exp AND [embase]/lim
#2. antibiotic*:ti,ab AND [embase]/lim
#3. #1 OR #2
#4. 'pneumonia'/exp AND [embase]/lim
#5. 'communicable disease'/exp AND [embase]/lim
#7. 'community acquired pneumonia'/exp AND [embase]/lim
#8. #4 AND #5
#9. 'community acquired pneumonia':ti,ab AND [embase]/lim
#10. #7 OR #8 OR #9
#11. #3 AND #10
#12. 'randomized controlled trial'/exp OR 'double blind procedure'/exp OR 'single blind procedure'/exp OR
'crossover procedure'/exp AND [embase]/lim
#13. random*:ti,ab OR factorial*:ti,ab OR crossover*:ti,ab OR 'cross over':ti,ab OR assign*:ti,ab OR allocat*:ti,ab OR volunteer*:ti,ab OR 'single blind':ti,ab OR 'single blinding':ti,ab OR 'single blinded':ti,ab OR 'double blind':ti,ab OR 'double blinded':ti,ab OR 'double blinding':ti,ab AND [embase]/lim
#14. #12 OR #13
#15. #11 AND #14
Appendix 2. Embase.com search strategy
#32 #23 AND #31
#31 #26 NOT #30
#30 #27 NOT #29
#29 #27 AND #28
#28 'human'/de
#27 'animal'/de OR 'nonhuman'/de OR 'animal experiment'/de
#26 #24 OR #25
#25 random*:ab,ti OR placebo*:ab,ti OR trial:ti OR allocat*:ab,ti OR crossover*:ab,ti OR 'cross over':ab,ti OR (doubl* NEXT/1 blind*):ab,ti
#24 'randomized controlled trial'/exp OR 'single blind procedure'/exp OR 'double blind procedure'/exp OR 'crossover procedure'/exp
#23 #14 AND #229264
#22 #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21
#21 macrolide*:ab,ti OR makrolide*:ab,ti OR quinolone*:ab,ti OR tetracycline*:ab,ti OR aciclovir:ab,ti OR amikacin:ab,ti OR amoxicillin:ab,ti OR amoxycillin:ab,ti OR ampicillin:ab,ti OR
azithromycin:ab,ti OR cefepim:ab,ti OR cefotaxim*:ab,ti OR ceftarolin:ab,ti OR ceftazidim*:ab,ti OR ceftibuten:ab,ti OR ceftriaxon*:ab,ti OR cefuroxim*:ab,ti OR cethromycin:ab,ti OR
ciprofloxacin:ab,ti OR clarithromycin:ab,ti OR 'clavulanic acid':ab,ti OR clindamycin:ab,ti OR doxycyclin*:ab,ti OR ertapenem:ab,ti OR erythromycin:ab,ti OR fluoroquinolon*:ab,ti OR fluorchinolon*:ab,ti OR gemifloxacin:ab,ti OR gentamicin:ab,ti OR imipenem:ab,ti OR levofloxacin:ab,ti OR linezolide:ab,ti OR meropenem:ab,ti OR moxifloxacin:ab,ti OR penicillin*:ab,ti OR piperacillin:ab,ti OR roxithromycin:ab,ti OR sultamicillin:ab,ti OR tazobactam:ab,ti OR tobramycin:ab,ti OR 'beta‐lactam':ab,ti OR 'beta‐lactams':ab,ti OR 'co‐amoxiclav':ab,ti OR 'co‐trimoxacol':ab,ti
#20 'tetracycline derivative'/exp
#19 'quinolone derivative'/de
#18 'beta lactam'/de
#17 'macrolide'/exp
#16 antibiotic*:ab,ti
#15 'antibiotic agent'/exp
#14 #1 OR #2 OR #13
#13 #5 AND #12
#12 #6 OR #7 OR #8 OR #9 OR #10 OR #11
#11 (ambulat* NEAR/2 (care OR patient*)):ab,ti
#10 'ambulatory care'/exp
#9 outpatient*:ab,ti OR 'out‐patient':ab,ti OR 'out‐patients':ab,ti
#8 'outpatient'/de
#7 'community acquired':ab,ti
#6 'communicable disease'/de
#5 #3 OR #4
#4 pneumon*:ab,ti
#3 'pneumonia'/exp
#2 'community acquired pneumonia':ab,ti OR cap:ab,ti
#1 'community acquired pneumonia'/de
Appendix 3. CINAHL (EBSCO) search strategy
S34 S23 and S33
S33 S24 or S25 or S26 or S27 or S28 or S29 or S30 or S31 or S32
S32 (MH "Random Assignment")
S31 (MH "Quantitative Studies")
S30 TI placebo* OR AB placebo*
S29 (MH "Placebos")
S28 TI random* OR AB random*
S27 TI ( (singl* or doubl* or tripl* or trebl*) W1 (blind* or mask*)) OR AB ((singl* or doubl* or tripl* or trebl*) W1 (blind* or mask*))
S26 TI clinical* trial* OR AB clinical* trial*
S25 PT clinical trial
S24 (MH "Clinical Trials+")
S23 S14 and S22
S22 S15 or S16 or S17 or S18 or S19 or S20 or S21
S21 TI (beta‐lactam* or macrolide* or makrolide* or quinolone* or tetracycline* or aciclovir or amikacin or amoxicillin or amoxycillin or ampicillin or azithromycin or cefepim or cefotaxim* or ceftarolin or
ceftazidim* or ceftibuten or ceftriaxon* or cefuroxim* or cethromycin or ciprofloxacin or clarithromycin or clavulanic acid or clindamycin or co‐amoxiclav or co‐trimoxacol or doxycyclin* or ertapenem or erythromycin or fluoroquinolon* or fluorchinolon* or gemifloxacin or gentamicin or imipenem or levofloxacin or linezolide or meropenem or moxifloxacin or penicillin* or piperacillin or roxithromycin or sultamicillin or tazobactam or telithromycin or tetracyclin* or ticarcillin or tobramycin) OR AB (beta‐lactam* or macrolide* or makrolide* or quinolone* or tetracycline* or aciclovir or amikacin or amoxicillin or amoxycillin or ampicillin or azithromycin or cefepim or cefotaxim* or ceftarolin or ceftazidim* or ceftibuten or ceftriaxon* or cefuroxim* or cethromycin or ciprofloxacin or clarithromycin or clavulanic acid or clindamycin or co‐amoxiclav or co‐trimoxacol or doxycyclin* or ertapenem or erythromycin or fluoroquinolon* or fluorchinolon* or gemifloxacin or gentamicin or imipenem or levofloxacin or linezolide or meropenem or moxifloxacin or penicillin* or piperacillin or roxithromycin or sultamicillin or tazobactam or telithromycin or tetracyclin* or ticarcillin or tobramycin)
S20 (MH "Antibiotics, Lactam+")
S19 (MH "Tetracyclines+") S
S18 (MH "Antiinfective Agents, Quinolone+")
S17 (MH "Antibiotics, Macrolide+")
S16 TI antibiotic* OR AB antibiotic*
S15 (MH "Antibiotics+")
S14 S11 or S12 or S13
S13 TI (community acquired pneumon* or cap) OR AB (community acquired pneumon* or cap)
S12 (MH "Community‐Acquired Pneumonia")
S11 S3 and S10
S10 S4 or S5 or S6 or S7 or S8 or S9 S
S9 TI (ambulat* N1 (care or patient*)) OR AB (ambulat* N1 (care or patient*))
S8 (MH "Ambulatory Care")
S7 TI (outpatient* or out patient*) OR AB (outpatient* or out patient*)
S6 (MH "Outpatients")
S5 TI community acquired OR AB community acquired
S4 (MH "Community‐Acquired Infections+")
S3 S1 or S2
S2 TI pneumon* OR AB pneumon*
S1 (MH "Pneumonia+")
Appendix 4. Web of Science (Thomson Reuters) search strategy
| # 9 | #7 AND #6 Refined by: Publication Years=( 2011 OR 2009 OR 2010 OR 2012 ) Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
| # 8 | #7 AND #6 Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
| # 7 | Title=(trial) OR Topic=(random* or placebo* or ((singl* or doubl*) NEAR/1 blind*)) Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
| # 6 | #5 AND #4 Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
| # 5 | Topic=(antibiotic* or beta‐lactam* or macrolide* or makrolide* or quinolone* or tetracycline* or aciclovir or amikacin or amoxicillin or amoxycillin or ampicillin or azithromycin or cefepim or cefotaxim* or ceftarolin or ceftazidim* or ceftibuten or ceftriaxon* or cefuroxim* or cethromycin or ciprofloxacin or clarithromycin or clavulanic acid or clindamycin or co‐amoxiclav or co‐trimoxacol or doxycyclin* or ertapenem or erythromycin or fluoroquinolon* or fluorchinolon* or gemifloxacin or gentamicin or imipenem or levofloxacin or linezolide or meropenem or moxifloxacin or penicillin* or piperacillin or roxithromycin or sultamicillin or tazobactam or telithromycin or tetracyclin* or ticarcillin or tobramycin) Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
| # 4 | #3 OR #2 OR #1 Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
| # 3 | Topic=((ambulat* NEAR/2 (care or patient* or setting)) NEAR/3 pneumon*) Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
| # 2 | Topic=((outpatient* or "out patient" or "out patients") NEAR/3 pneumon*) Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
| # 1 | Topic=(community acquired*) AND Topic=(pneumonia) Databases=SCI‐EXPANDED, CPCI‐S, CCR‐EXPANDED, IC Timespan=1985‐2012 Lemmatization=On | |
Appendix 5. LILACS (BIREME) search strategy
Search > ("community‐acquired pneumonia" OR ((MH:pneumonia OR pneumon$ OR Neumonía OR MH:C08.381.677$ OR MH:C08.730.610$) AND (MH:"Community‐Acquired Infections" OR "Community‐Acquired Infections" OR
"Infecciones Comunitarias Adquiridas" OR "Infecções Comunitárias Adquiridas" OR MH:Outpatients OR outpatient$ OR "out patient" OR "out patients" OR "Pacientes Ambulatorios" OR "Pacientes
Ambulatoriais" OR MH:"Ambulatory Care" OR "ambulatory care" OR "Atención Ambulatoria" OR "Assistência Ambulatorial" OR "Cuidados Ambulatorios" OR "Cuidados de Pacientes Externos" OR "Cuidados
ambulatoriais"))) AND (MH:"Anti‐Bacterial Agents" OR antibiot$ OR antibacteria$ OR MH:macrolides OR Macrólidos OR Macrolídeos OR MH:D02.540.505$ OR MH:"beta‐Lactams" OR "beta‐Lactamas" OR
MH:D02.065.589.099$ OR MH:D02.886.108$ OR MH:D04.075.080.875.099.221$ OR MH:Quinolones OR Quinolonas OR Quinolinones OR Ketoquinolines OR Oxoquinolines OR MH:D03.438.810.835$ OR MH:Tetracyclines OR
tetraciclinas OR tetraciclinas OR MH:D02.455.426.559.847.562.900$ OR MH:D04.615.562.900$ OR "beta‐lactam" OR "beta‐lactams" OR macrolide$ OR makrolide$ OR quinolone$ OR tetracycline$ OR aciclovir OR
amikacin OR amoxicillin OR amoxycillin OR ampicillin OR azithromycin OR cefepim OR cefotaxim$ OR ceftarolin OR ceftazidim$ OR ceftibuten OR ceftriaxon$ OR cefuroxim$ OR cethromycin OR ciprofloxacin OR
clarithromycin OR "clavulanic acid" OR clindamycin OR "co‐amoxiclav" OR "co‐trimoxacol" OR doxycyclin$ OR ertapenem OR erythromycin OR fluoroquinolon$ OR fluorchinolon$ OR gemifloxacin OR gentamicin
OR imipenem OR levofloxacin OR linezolide OR meropenem OR moxifloxacin OR penicillin$ OR piperacillin OR roxithromycin OR sultamicillin OR tazobactam OR telithromycin OR tetracyclin$ OR ticarcillin OR
tobramycin) > clinical_trials
Figure1: Antibiotic comparisons in new studies included in this review. The red arrow indicates antibiotic comparisons studied in Udupa 2011.
Figure 2. Overview of included studies and antibiotic pairs studied in 2009 review. *Indicates studies new to this review; shaded ovals indicate quinolones (gyrase inhibitors), white ovals indicate macrolides
'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.
Comparison 1 Solithromycin versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 1 Solithromycin versus levofloxacin, Outcome 2 Bacteriological cure.
Comparison 1 Solithromycin versus levofloxacin, Outcome 3 Adverse events.
Comparison 2 Nemonoxacin versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 2 Nemonoxacin versus levofloxacin, Outcome 2 Bacteriological cure.
Comparison 2 Nemonoxacin versus levofloxacin, Outcome 3 Adverse events.
Comparison 3 Nemonoxacin versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 3 Nemonoxacin versus levofloxacin, Outcome 2 Bacteriological cure.
Comparison 3 Nemonoxacin versus levofloxacin, Outcome 3 Adverse events.
Comparison 4 Clarithromycin versus amoxicillin, Outcome 1 Test‐of‐clinical‐cure.
| Study | Antibiotics | Events | Total |
| Udupa 2011 | Clarithromycin | 8 | |
| Udupa 2011 | Azithromycin | 7 | |
| Udupa 2011 | Levofloxacin | 7 | |
| Udupa 2011 | High‐dose amoxicillin | 9 | |
Comparison 5 Clarithromycin versus azithromycin versus levofloxacin versus amoxicillin, Outcome 1 Test‐of‐clinical‐cure.
| Study | Antibiotic | Events | Total |
| Udupa 2011 | Clarithromycin | 4 | 8 |
| Udupa 2011 | Azithromycin | 5 | 7 |
| Udupa 2011 | Levofloxacin | 5 | 7 |
| Udupa 2011 | Amoxicillin | 7 | 9 |
Comparison 5 Clarithromycin versus azithromycin versus levofloxacin versus amoxicillin, Outcome 2 Adverse events.
Comparison 6 Cethromycin versus clarithromycin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 6 Cethromycin versus clarithromycin, Outcome 2 Bacteriological cure.
Comparison 6 Cethromycin versus clarithromycin, Outcome 3 Adverse events.
Comparison 7 Clarithromycin versus erythromycin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 7 Clarithromycin versus erythromycin, Outcome 2 Bacteriological cure.
Comparison 7 Clarithromycin versus erythromycin, Outcome 3 Radiological cure.
Comparison 7 Clarithromycin versus erythromycin, Outcome 4 Adverse events.
Comparison 8 Azithromycin microspheres versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 8 Azithromycin microspheres versus levofloxacin, Outcome 2 Bacteriological cure.
Comparison 8 Azithromycin microspheres versus levofloxacin, Outcome 3 Adverse events.
Comparison 9 Azithromycin microspheres versus clarithromycin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 9 Azithromycin microspheres versus clarithromycin, Outcome 2 Bacteriological cure.
Comparison 9 Azithromycin microspheres versus clarithromycin, Outcome 3 Adverse events.
Comparison 10 Telithromycin versus clarithromycin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 10 Telithromycin versus clarithromycin, Outcome 2 Bacteriological cure.
Comparison 10 Telithromycin versus clarithromycin, Outcome 3 Adverse events.
Comparison 11 Telithromycin versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.
Comparison 11 Telithromycin versus levofloxacin, Outcome 2 Bacteriological cure.
Comparison 11 Telithromycin versus levofloxacin, Outcome 3 Clinical efficacy against H. influenzae.
Comparison 11 Telithromycin versus levofloxacin, Outcome 4 Adverse events.
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 132 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.32, 2.26] |
| 2 Bacteriological cure Show forest plot | 1 | 32 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.4 [0.28, 6.98] |
| 3 Adverse events Show forest plot | 1 | 132 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.52 [0.19, 1.40] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 176 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.18 [0.55, 2.53] |
| 2 Bacteriological cure Show forest plot | 1 | 91 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.80 [0.19, 3.44] |
| 3 Adverse events Show forest plot | 1 | 176 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.32 [0.73, 2.39] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 179 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.76 [0.38, 1.54] |
| 2 Bacteriological cure Show forest plot | 1 | 96 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.48 [0.13, 1.78] |
| 3 Adverse events Show forest plot | 1 | 179 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.47, 1.54] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 42 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.0 [0.0, 0.0] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | Other data | No numeric data | ||
| 2 Adverse events Show forest plot | Other data | No numeric data | ||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 1025 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.87 [0.63, 1.22] |
| 2 Bacteriological cure Show forest plot | 1 | 363 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.89 [0.50, 1.58] |
| 3 Adverse events Show forest plot | 1 | 1096 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.68 [1.32, 2.15] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 2 | 280 | Odds Ratio (M‐H, Fixed, 95% CI) | 2.27 [0.66, 7.80] |
| 2 Bacteriological cure Show forest plot | 2 | 57 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.28 [0.03, 2.57] |
| 3 Radiological cure Show forest plot | 2 | 276 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.91 [0.33, 2.49] |
| 4 Adverse events Show forest plot | 2 | 476 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.30 [0.20, 0.46] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 363 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.59 [0.27, 1.26] |
| 2 Bacteriological cure Show forest plot | 1 | 237 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.81 [0.32, 2.02] |
| 3 Adverse events Show forest plot | 1 | 423 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.78 [1.04, 3.03] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 411 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.69 [0.31, 1.55] |
| 2 Bacteriological cure Show forest plot | 1 | 303 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.17 [0.52, 2.61] |
| 3 Adverse events Show forest plot | 1 | 499 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.09 [0.73, 1.64] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 318 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.98 [0.49, 1.95] |
| 2 Bacteriological cure Show forest plot | 1 | 62 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.24 [0.03, 2.29] |
| 3 Adverse events Show forest plot | 1 | 443 | Odds Ratio (M‐H, Fixed, 95% CI) | 1.61 [1.08, 2.40] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Test‐of‐clinical‐cure Show forest plot | 1 | 123 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.85 [0.14, 5.25] |
| 2 Bacteriological cure Show forest plot | 1 | 86 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.03 [0.00, 0.60] |
| 3 Clinical efficacy against H. influenzae Show forest plot | 1 | 46 | Odds Ratio (M‐H, Fixed, 95% CI) | 4.62 [0.38, 55.51] |
| 4 Adverse events Show forest plot | 1 | 240 | Odds Ratio (M‐H, Fixed, 95% CI) | 0.99 [0.58, 1.68] |
