Macrolides for better resolution of community-acquired pneumonia: A global meta-analysis of clinical outcomes with focus on microbial etiology

Abstract

Objectives: This meta-analysis examined the impact of macrolides on resolution of CAP and interpretation of clinical benefit according to microbiology; emphasis is given to data under-reported countries (URCs).Methods: This meta-analysis included 63 publications published between 1994 and 2022. Publications were analyzed for resolution of CAP (6,465 patients) and 30-day mortality (58,759 patients). A separate meta-analysis was done for the prevalence of respiratory pathogens in URCs.Results: Mortality after 30 days was reduced by the addition of macrolides (OR 0.65, 95% CI 0.51-0.82). The odds ratio (OR) of CAP resolution when macrolides were added to the treatment regimen was 1.23 (95% confidence interval [CI] 1.00-1.52). The most prevalent pathogen was Streptococcus pneumoniae (12.68%; 95% CI 9.36-16.95%). Analysis of the epidemiology from the URCs included 12 publications. The most prevalent pathogens were S. pneumoniae (24.91%) and Klebsiella pneumoniae (12.90%).Conclusions: The addition of macrolides to the treatment regimen led to relative 35% decrease of 30-day mortality and to 23% relative increase resolution of CAP.Registration: PROSPERO; number CRD42022325280