Antibiotics for community‐acquired pneumonia in adult outpatients

Smita Pakhale; Sunita Mulpuru; Theo JM Verheij; Michael M Kochen; Gernot GU Rohde; Lise M Bjerre

doi:10.1002/14651858.CD002109.pub4

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Figure 1

Figure1: Antibiotic comparisons in new studies included in this review. The red arrow indicates antibiotic comparisons studied in Udupa 2011.

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Figure 2

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

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Figure 3

'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

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Figure 4

'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.

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Analysis 1.1

Comparison 1 Solithromycin versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 1.2

Comparison 1 Solithromycin versus levofloxacin, Outcome 2 Bacteriological cure.

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Analysis 1.3

Comparison 1 Solithromycin versus levofloxacin, Outcome 3 Adverse events.

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Analysis 2.1

Comparison 2 Nemonoxacin versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 2.2

Comparison 2 Nemonoxacin versus levofloxacin, Outcome 2 Bacteriological cure.

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Analysis 2.3

Comparison 2 Nemonoxacin versus levofloxacin, Outcome 3 Adverse events.

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Analysis 3.1

Comparison 3 Nemonoxacin versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 3.2

Comparison 3 Nemonoxacin versus levofloxacin, Outcome 2 Bacteriological cure.

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Analysis 3.3

Comparison 3 Nemonoxacin versus levofloxacin, Outcome 3 Adverse events.

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Analysis 4.1

Comparison 4 Clarithromycin versus amoxicillin, Outcome 1 Test‐of‐clinical‐cure.

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Study	Antibiotics	Events	Total
Udupa 2011	Clarithromycin		8
Udupa 2011	Azithromycin		7
Udupa 2011	Levofloxacin		7
Udupa 2011	High‐dose amoxicillin		9

Analysis 5.1

Comparison 5 Clarithromycin versus azithromycin versus levofloxacin versus amoxicillin, Outcome 1 Test‐of‐clinical‐cure.

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Study	Antibiotic	Events	Total
Udupa 2011	Clarithromycin	4	8
Udupa 2011	Azithromycin	5	7
Udupa 2011	Levofloxacin	5	7
Udupa 2011	Amoxicillin	7	9

Analysis 5.2

Comparison 5 Clarithromycin versus azithromycin versus levofloxacin versus amoxicillin, Outcome 2 Adverse events.

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Analysis 6.1

Comparison 6 Cethromycin versus clarithromycin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 6.2

Comparison 6 Cethromycin versus clarithromycin, Outcome 2 Bacteriological cure.

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Analysis 6.3

Comparison 6 Cethromycin versus clarithromycin, Outcome 3 Adverse events.

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Analysis 7.1

Comparison 7 Clarithromycin versus erythromycin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 7.2

Comparison 7 Clarithromycin versus erythromycin, Outcome 2 Bacteriological cure.

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Analysis 7.3

Comparison 7 Clarithromycin versus erythromycin, Outcome 3 Radiological cure.

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Analysis 7.4

Comparison 7 Clarithromycin versus erythromycin, Outcome 4 Adverse events.

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Analysis 8.1

Comparison 8 Azithromycin microspheres versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 8.2

Comparison 8 Azithromycin microspheres versus levofloxacin, Outcome 2 Bacteriological cure.

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Analysis 8.3

Comparison 8 Azithromycin microspheres versus levofloxacin, Outcome 3 Adverse events.

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Analysis 9.1

Comparison 9 Azithromycin microspheres versus clarithromycin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 9.2

Comparison 9 Azithromycin microspheres versus clarithromycin, Outcome 2 Bacteriological cure.

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Analysis 9.3

Comparison 9 Azithromycin microspheres versus clarithromycin, Outcome 3 Adverse events.

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Analysis 10.1

Comparison 10 Telithromycin versus clarithromycin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 10.2

Comparison 10 Telithromycin versus clarithromycin, Outcome 2 Bacteriological cure.

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Analysis 10.3

Comparison 10 Telithromycin versus clarithromycin, Outcome 3 Adverse events.

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Analysis 11.1

Comparison 11 Telithromycin versus levofloxacin, Outcome 1 Test‐of‐clinical‐cure.

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Analysis 11.2

Comparison 11 Telithromycin versus levofloxacin, Outcome 2 Bacteriological cure.

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Analysis 11.3

Comparison 11 Telithromycin versus levofloxacin, Outcome 3 Clinical efficacy against H. influenzae.

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Analysis 11.4

Comparison 11 Telithromycin versus levofloxacin, Outcome 4 Adverse events.

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Comparison 1. Solithromycin versus levofloxacin

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]

Comparison 1. Solithromycin versus levofloxacin

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Comparison 2. Nemonoxacin versus levofloxacin

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]

Comparison 2. Nemonoxacin versus levofloxacin

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Comparison 3. Nemonoxacin versus levofloxacin

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]

Comparison 3. Nemonoxacin versus levofloxacin

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Comparison 4. Clarithromycin versus amoxicillin

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]

Comparison 4. Clarithromycin versus amoxicillin

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Comparison 5. Clarithromycin versus azithromycin versus levofloxacin versus amoxicillin

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

Comparison 5. Clarithromycin versus azithromycin versus levofloxacin versus amoxicillin

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Comparison 6. Cethromycin versus clarithromycin

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]

Comparison 6. Cethromycin versus clarithromycin

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Comparison 7. Clarithromycin versus erythromycin

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]

Comparison 7. Clarithromycin versus erythromycin

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Comparison 8. Azithromycin microspheres versus levofloxacin

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]

Comparison 8. Azithromycin microspheres versus levofloxacin

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Comparison 9. Azithromycin microspheres versus clarithromycin

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]

Comparison 9. Azithromycin microspheres versus clarithromycin

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Comparison 10. Telithromycin versus clarithromycin

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]

Comparison 10. Telithromycin versus clarithromycin

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Comparison 11. Telithromycin versus levofloxacin

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]

Comparison 11. Telithromycin versus levofloxacin

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