Efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia: an overview of systematic reviews_West China Medical Journal

Authors：

ZHANG Yonggang ^1,2 , WANG Dongguang ³ , ZHENG Linli ⁴ ,  FAN Hong ³

1. West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
4. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FAN Hong, Email: fanhongfan@qq.com

Keywords：

Respiratory fluoroquinolones; Community-acquired pneumonia; Overview of systematic reviews; AMSTAR; β-lactams; Macrolides

DOI：

10.7507/1002-0179.201712079

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Objective To overview the systematic reviews about the efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia (CAP). Methods We electronically searched databases including China National Knowledge Internet, WanFang Data, VIP, PubMed, Embase and The Cochrane Library to collect systematic reviews or Meta-analyses about respiratory fluoroquinolones for CAP from inception to November 2, 2017. Two reviewers independently screened literatures, extracted data, and then AMSTAR tool was used to assess the methodological quality of included studies. Results A total of 18 systematic reviews/Meta-analyses were included. The results of quality assessment indicated the scores ranged from 5 to 10. Among the 11 items, the item 1 of " Was an ‘a priori’ design provided” and item 4 " Was the status of publication (i.e. grey literature) used as an inclusion criterion” appeared to be the most problematic. The results of overview suggested that: the efficacy of respiratory fluoroquinolones might be similar to β-lactams plus macrolides combination treatment for CAP. However, respiratory fluoroquinolones might be more safety. In addition, the efficacy of respiratory fluoroquinolones sequential therapy for CAP was similar to that of continuous intravenous therapy, but the adverse reactions of the former were fewer. Conclusions Respiratory fluoroquinolones might be similar in efficacy for CAP to other antibiotics recommended by the guidelines with less adverse reactions. However, it can increase multi-drug resistance and potential tuberculosis drug resistance, we should strictly follow the principle of rational use of antibiotics to avoid abuse.

Citation： ZHANG Yonggang, WANG Dongguang, ZHENG Linli, FAN Hong. Efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia: an overview of systematic reviews. West China Medical Journal, 2018, 33(1): 47-52. doi: 10.7507/1002-0179.201712079 Copy

1.	李勉珊, 吴久鸿, 张忆文. 莫西沙星治疗国内社区获得性肺炎的 Meta 分析. 实用药物与临床, 2011, 14(3): 203-206.
2.	任静, 杨蒙蒙, 衡宇, 等. 替加环素对比左氧氟沙星治疗社区获得性肺炎疗效与安全性的 Meta 分析. 药物流行病学杂志, 2015, 24(10): 577-581.
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4.	Pakhale S, Mulpuru S, Verheij TJ, et al. Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst Rev, 2014 (10): CD002109.
5.	刘武胜, 李如梅, 宋志锋, 等. 国内莫西沙星治疗老年社区获得性肺炎的临床疗效的 meta 分析. 当代医学, 2017, 23(9): 8-10.
6.	王晖, 田瑜, 耿男. 莫西沙星对比阿奇霉素治疗社区获得性肺炎有效性和安全性的系统评价. 甘肃科技, 2015, 31(22): 139-143, 133.
7.	范红, 刘思彤, 童翔, 等. 呼吸喹诺酮类与 β-内酰胺类联合大环内酯类治疗非 ICU 住院社区获得性肺炎患者有效性和安全性的系统评价. 中国循证医学杂志, 2015, 15(7): 824-832.
8.	An MM, Zou Z, Shen H, et al. Moxifloxacin monotherapy versus beta-lactam-based standard therapy for community-acquired pneumonia: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents, 2010, 36(1): 58-65.
9.	Maimon N, Nopmaneejumruslers C, Marras TK. Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis. Eur Respir J, 2008, 31(5): 1068-1076.
10.	Yuan X, Liang BB, Wang R, et al. Treatment of community-acquired pneumonia with moxifloxacin: a meta-analysis of randomized controlled trials. J Chemother, 2012, 24(5): 257-267.
11.	王明华, 贾雪冬. 大环内酯与喹诺酮治疗社区获得性肺炎随机对照试验的 Meta 分析. 国外医药: 抗生素分册, 2013, 34(4): 161-164.
12.	朱泓霞, 狄小园, 脱鸣富, 等. 单用氟喹诺酮类药物对比 β-内酰胺类联用大环内酯类药物治疗社区获得性肺炎的有效性和安全性的系统评价. 中国药房, 2013, 24(40): 3813-3816.
13.	熊俊, 陈日新. 系统评价/Meta 分析方法学质量的评价工具 AMSTAR. 中国循证医学杂志, 2011, 11(9): 1084-1089.
14.	Mills GD, Oehley MR, Arrol B. Effectiveness of beta lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis. BMJ, 2005, 330(7489): 456.
15.	Raz-Pasteur A, Shasha D, Paul M. Fluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: systematic review and meta-analysis. Int J Antimicrob Agents, 2015, 46(3): 242-248.
16.	Skalsky K, Yahav D, Lador A, et al. Macrolides vs. quinolones for community-acquired pneumonia: meta-analysis of randomized controlled trials. Clin Microbiol Infect, 2013, 19(4): 370-378.
17.	Vardakas KZ, Siempos II, Grammatikos A, et al. Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials. Can Med Assoc J, 2008, 179(12): 1269-1277.
18.	Zhang L, Wang R, Matthew FE, et al. Gemifloxacin for the treatment of community-acquired pneumonia and acute exacerbation of chronic bronchitis: a meta-analysis of randomized controlled trials. Chin Med J (Engl), 2012, 125(4): 687-695.
19.	范晓萍, 嵇宏亮, 留永咏. 莫西沙星序贯治疗社区获得性肺炎的 Meta 分析. 药物流行病学杂志, 2013, 22(6): 288-291.
20.	王建波. 左氧氟沙星序贯疗法治疗社区获得性肺炎的 Meta 分析. 中华全科医学, 2014, 12(10): 1642-1644.

1. 李勉珊, 吴久鸿, 张忆文. 莫西沙星治疗国内社区获得性肺炎的 Meta 分析. 实用药物与临床, 2011, 14(3): 203-206.
2. 任静, 杨蒙蒙, 衡宇, 等. 替加环素对比左氧氟沙星治疗社区获得性肺炎疗效与安全性的 Meta 分析. 药物流行病学杂志, 2015, 24(10): 577-581.
3. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016 年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
4. Pakhale S, Mulpuru S, Verheij TJ, et al. Antibiotics for community-acquired pneumonia in adult outpatients. Cochrane Database Syst Rev, 2014 (10): CD002109.
5. 刘武胜, 李如梅, 宋志锋, 等. 国内莫西沙星治疗老年社区获得性肺炎的临床疗效的 meta 分析. 当代医学, 2017, 23(9): 8-10.
6. 王晖, 田瑜, 耿男. 莫西沙星对比阿奇霉素治疗社区获得性肺炎有效性和安全性的系统评价. 甘肃科技, 2015, 31(22): 139-143, 133.
7. 范红, 刘思彤, 童翔, 等. 呼吸喹诺酮类与 β-内酰胺类联合大环内酯类治疗非 ICU 住院社区获得性肺炎患者有效性和安全性的系统评价. 中国循证医学杂志, 2015, 15(7): 824-832.
8. An MM, Zou Z, Shen H, et al. Moxifloxacin monotherapy versus beta-lactam-based standard therapy for community-acquired pneumonia: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents, 2010, 36(1): 58-65.
9. Maimon N, Nopmaneejumruslers C, Marras TK. Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis. Eur Respir J, 2008, 31(5): 1068-1076.
10. Yuan X, Liang BB, Wang R, et al. Treatment of community-acquired pneumonia with moxifloxacin: a meta-analysis of randomized controlled trials. J Chemother, 2012, 24(5): 257-267.
11. 王明华, 贾雪冬. 大环内酯与喹诺酮治疗社区获得性肺炎随机对照试验的 Meta 分析. 国外医药: 抗生素分册, 2013, 34(4): 161-164.
12. 朱泓霞, 狄小园, 脱鸣富, 等. 单用氟喹诺酮类药物对比 β-内酰胺类联用大环内酯类药物治疗社区获得性肺炎的有效性和安全性的系统评价. 中国药房, 2013, 24(40): 3813-3816.
13. 熊俊, 陈日新. 系统评价/Meta 分析方法学质量的评价工具 AMSTAR. 中国循证医学杂志, 2011, 11(9): 1084-1089.
14. Mills GD, Oehley MR, Arrol B. Effectiveness of beta lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis. BMJ, 2005, 330(7489): 456.
15. Raz-Pasteur A, Shasha D, Paul M. Fluoroquinolones or macrolides alone versus combined with β-lactams for adults with community-acquired pneumonia: systematic review and meta-analysis. Int J Antimicrob Agents, 2015, 46(3): 242-248.
16. Skalsky K, Yahav D, Lador A, et al. Macrolides vs. quinolones for community-acquired pneumonia: meta-analysis of randomized controlled trials. Clin Microbiol Infect, 2013, 19(4): 370-378.
17. Vardakas KZ, Siempos II, Grammatikos A, et al. Respiratory fluoroquinolones for the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials. Can Med Assoc J, 2008, 179(12): 1269-1277.
18. Zhang L, Wang R, Matthew FE, et al. Gemifloxacin for the treatment of community-acquired pneumonia and acute exacerbation of chronic bronchitis: a meta-analysis of randomized controlled trials. Chin Med J (Engl), 2012, 125(4): 687-695.
19. 范晓萍, 嵇宏亮, 留永咏. 莫西沙星序贯治疗社区获得性肺炎的 Meta 分析. 药物流行病学杂志, 2013, 22(6): 288-291.
20. 王建波. 左氧氟沙星序贯疗法治疗社区获得性肺炎的 Meta 分析. 中华全科医学, 2014, 12(10): 1642-1644.

West China Medical Journal

Efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia: an overview of systematic reviews

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