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, 吳久鴻, 張憶文. 莫西沙星治療國內社區獲得性肺炎的 Meta 分析. 實用藥物與臨床, 2011, 14(3): 203-206.
2.	任靜, 楊蒙蒙, 衡宇, 等. 替加環素對比左氧氟沙星治療社區獲得性肺炎療效與安全性的 Meta 分析. 藥物流行病學雜志, 2015, 24(10): 577-581.
3.	中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016 年版). 中華結核和呼吸雜志, 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.	劉武勝, 李如梅, 宋志鋒, 等. 國內莫西沙星治療老年社區獲得性肺炎的臨床療效的 meta 分析. 當代醫學, 2017, 23(9): 8-10.
6.	王暉, 田瑜, 耿男. 莫西沙星對比阿奇霉素治療社區獲得性肺炎有效性和安全性的系統評價. 甘肅科技, 2015, 31(22): 139-143, 133.
7.	范紅, 劉思彤, 童翔, 等. 呼吸喹諾酮類與 β-內酰胺類聯合大環內酯類治療非 ICU 住院社區獲得性肺炎患者有效性和安全性的系統評價. 中國循證醫學雜志, 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.	王明華, 賈雪冬. 大環內酯與喹諾酮治療社區獲得性肺炎隨機對照試驗的 Meta 分析. 國外醫藥: 抗生素分冊, 2013, 34(4): 161-164.
12.	朱泓霞, 狄小園, 脫鳴富, 等. 單用氟喹諾酮類藥物對比 β-內酰胺類聯用大環內酯類藥物治療社區獲得性肺炎的有效性和安全性的系統評價. 中國藥房, 2013, 24(40): 3813-3816.
13.	熊俊, 陳日新. 系統評價/Meta 分析方法學質量的評價工具 AMSTAR. 中國循證醫學雜志, 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.	范曉萍, 嵇宏亮, 留永詠. 莫西沙星序貫治療社區獲得性肺炎的 Meta 分析. 藥物流行病學雜志, 2013, 22(6): 288-291.
20.	王建波. 左氧氟沙星序貫療法治療社區獲得性肺炎的 Meta 分析. 中華全科醫學, 2014, 12(10): 1642-1644.

1. 李勉珊, 吳久鴻, 張憶文. 莫西沙星治療國內社區獲得性肺炎的 Meta 分析. 實用藥物與臨床, 2011, 14(3): 203-206.
2. 任靜, 楊蒙蒙, 衡宇, 等. 替加環素對比左氧氟沙星治療社區獲得性肺炎療效與安全性的 Meta 分析. 藥物流行病學雜志, 2015, 24(10): 577-581.
3. 中華醫學會呼吸病學分會. 中國成人社區獲得性肺炎診斷和治療指南(2016 年版). 中華結核和呼吸雜志, 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. 劉武勝, 李如梅, 宋志鋒, 等. 國內莫西沙星治療老年社區獲得性肺炎的臨床療效的 meta 分析. 當代醫學, 2017, 23(9): 8-10.
6. 王暉, 田瑜, 耿男. 莫西沙星對比阿奇霉素治療社區獲得性肺炎有效性和安全性的系統評價. 甘肅科技, 2015, 31(22): 139-143, 133.
7. 范紅, 劉思彤, 童翔, 等. 呼吸喹諾酮類與 β-內酰胺類聯合大環內酯類治療非 ICU 住院社區獲得性肺炎患者有效性和安全性的系統評價. 中國循證醫學雜志, 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. 王明華, 賈雪冬. 大環內酯與喹諾酮治療社區獲得性肺炎隨機對照試驗的 Meta 分析. 國外醫藥: 抗生素分冊, 2013, 34(4): 161-164.
12. 朱泓霞, 狄小園, 脫鳴富, 等. 單用氟喹諾酮類藥物對比 β-內酰胺類聯用大環內酯類藥物治療社區獲得性肺炎的有效性和安全性的系統評價. 中國藥房, 2013, 24(40): 3813-3816.
13. 熊俊, 陳日新. 系統評價/Meta 分析方法學質量的評價工具 AMSTAR. 中國循證醫學雜志, 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. 范曉萍, 嵇宏亮, 留永詠. 莫西沙星序貫治療社區獲得性肺炎的 Meta 分析. 藥物流行病學雜志, 2013, 22(6): 288-291.
20. 王建波. 左氧氟沙星序貫療法治療社區獲得性肺炎的 Meta 分析. 中華全科醫學, 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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