Meta-analysis of fluoroquinolones versus macrolides for treatment of legionella pneumonia

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 27; no. 3; pp. 424 - 433
• Main Authors: Kato, Hideo, Hagihara, Mao, Asai, Nobuhiro, Shibata, Yuichi, Koizumi, Yusuke, Yamagishi, Yuka, Mikamo, Hiroshige
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-03-2021
• Subjects: Legionella pneumonia; Macrolide; Meta-analysis; Mortality; Quinolone; RR; Quinolone; CSs; OR; Legionella pneumonia; Mortality; CI; RCTs; FQs; MCs; Macrolide; Meta-analysis
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1016/j.jiac.2020.10.002

Only a single meta-analysis has reported the clinical benefit of fluoroquinolones (FQs) for Legionella pneumonia; however, there is no robust data available to confirm this result, based on current guidelines.
We performed a systematic review and meta-analysis comparing FQs with macrolides (MCs) on their efficacy and safety in Legionella pneumonia, using studies published until January 2020. The outcomes included mortality (overall; 30-day), clinical cure, time to apyrexia, length of hospital stay, and adverse events.
Five RCTs and twelve retrospective studies were identified. Clinical cure was comparable between the treatment groups (risk rate (RR) 1.07, 95% confidential interval (CI) 0.86–1.31). Mortality was significantly higher for MCs than for FQs (overall, odd rate (OR) 0.59, 95% CI 0.35–0.98; 30-day, OR 0.41, 95% CI 0.20–0.85). FQs significantly reduced the length of hospital stay, compared to MCs (mean difference −3.58, 95% CI -5.48–1.69). Other outcomes were not significantly different between the treatment groups (time to apyrexia; mean difference −1.83, 95% CI -5.15–1.5, adverse events; OR 0.61, 95% CI 0.33–1.15). In subgroup analyses, levofloxacin significantly reduced the length of hospital stay over two specific MCs (azithromycin and clarithromycin) (mean difference −3.03, 95% CI -5.33–0.72), whereas mortality was not significantly different between the treatment groups (overall, OR 0.49, 95% CI 0.19–1.24; 30-day, OR 0.38, 95% CI 0.13–1.13).
FQs exhibited superior effects in terms of mortality and length of hospital stay in Legionella pneumonia. These results support current guidelines recommending FQs for the treatment of Legionella pneumonia.