Table 3.
Summary of findings on community-acquired pneumonia and lower respiratory tract infections (n = 15 studies)
| Study ID | Country(s) | Design | Population | N | Intervention | Outcome | Key findings | RoB |
|
|---|---|---|---|---|---|---|---|---|---|
|
Antibiotic
| |||||||||
| Abengowe, 1979 [57] |
Nigeria |
RCT |
14-65 y with acute LRTI |
126 |
Cotrimoxazole (TMP-SMX) 480-2400mg BID vs Tetracycline 500mg Q6H |
Clinical improvement (composite of sputum characteristics, normal temperature, normal chest x-ray); side effects |
Clinical improvement (in all three criteria) greater in treatment group (68.2% vs 36.5%, P < 0.01). x-ray changes resolved within 14 d more frequently in the treatment group (43 vs 23 patients, P < 0.001). |
Some Concerns |
|
| Chaudhary, 2009 [58] |
India |
RCT |
≥18 y hospitalized with lower respiratory tract infection |
240 |
IV Ceftazidime-Tobramycin 1g-120mg vs IV Ceftriaxone 1g |
Clinical cure rate; chest radiograph improvement |
Higher cure rate in 88.4% of the patients in Ceftazidime-Tobramycin FDC treated group as compared to 61.2% in cefatzidime alone treated group, with significant reduction in symptoms of dyspnoea, fever, cough, sputum, hemoptysis and chest pain in the patients |
High |
|
| Izadi, 2018 [59] |
Iran |
RCT |
≥14 y hospitalized with CAP |
150 |
PO Levofloxacin 750mg vs IV Ceftriaxone 1g BID + Azithromycin 250mg |
Clinical Improvement (clinical signs and laboratory values); Hospital LOS |
No difference in clinical improvement or hospital LOS (3.3 ± 0.7 vs 3.4 ± 0.6, P = 0.15) between levofloxacin monotherapy vs ceftriaxone + azithromycin. |
Some Concerns |
|
| Loh, 2005 [60] |
Malaysia |
Prospective cohort |
>12 y with CAP |
141 |
Addition of macrolide to a broad-spectrum antibiotic within 24 h of admission |
In-hospital mortality |
No difference in mortality with addition of macrolide (non-severe pneumonia, 6.5% vs 5.4%, P = 0.804; severe pneumonia, 17.6% vs 18.2%, P = 0.966). No difference in median hospital LOS (non-severe pneumonia, 5.5 vs 5 d, P = 0.954; severe pneumonia, 7 vs 6 d, P = 0.401). |
Moderate |
|
| Mendonça, 2004 [61] |
Brazil |
RCT |
≥18 y hospitalized with mild to moderately severe pneumonia |
51 |
IV/PO Gatifloxacin 400mg daily vs IV Ceftriaxone 1-2g daily (with or without macrolide) |
Clinical cure rate (cure, failure, undetermined) |
No difference in clinical cure rate between gatifloxacin vs ceftriaxone (92% and 88%). |
Some Concerns |
|
| Tieying, 2014 [62] |
China |
RCT |
≥18 y with CAP and aspiration risk factors |
77 |
IV Moxifloxacin 400mg daily vs IV Levofloxacin 500mg daily + Metronidazole 500mg BID |
Clinical cure rate at 7-14 d |
Clinical cure at 7 d after treatment were 76.7% for the moxifloxacin-treated patients, compared with 51.7% for the levofloxacin plus metronidazole-treated patients (χ2 = 4.002, P = 0.045). No difference in cure rate for moxifloxacin (83.3%) vs levofloxacin/metronidazole (71.8%) (P = 0.233) at end of treatment period. |
High |
|
| Wang, 2013 [63] |
China |
RCT |
18-70 y with LRTI |
272 |
IV Biapenem 300mg BID vs IV Meropenem 500mg Q8H |
Clinical efficacy |
No significant difference in clinical efficacy between biapenem and meropenem (94.7% vs 93.75%) for lower respiratory tract infection |
Low |
|
| Zhao, 2014 [64] |
China |
RCT |
18-70 y with CAP |
223 |
IV Levofloxacin 750mg for 5 d vs 500mg for 7-14 d |
Clinical cure rate |
There was no significant difference between the overall cure rate (56% vs 56.8%; difference = -0.8; 95% CI = -13.9 to 12.3) or efficacy rate (1.6%; 95% CI = -7.8 to 10.9) between levofloxacin 750mg for 5 d vs 500mg for 7-14d |
Low |
|
| Zhong, 2015 [65] |
China, India, South Korea, Taiwan, and Vietnam |
RCT |
≥18 y with radiographically confirmed pneumonia |
771 |
IV Ceftaroline 600mg BID vs IV Ceftriaxone 2g |
Clinical cure rate |
Clinical cure rate greater in ceftaroline 600mg q12h vs ceftriaxone 2g q24h (84% vs 74%; 95% CI = 2.8 to 17.1) |
Some Concerns |
|
|
Corticosteroid
| |||||||||
| Iqbal, 2020 [66] |
Pakistan |
Retrospective cohort |
≥18 y with CAP |
508 |
IV Hydrocortisone 100mg Q8H then PO Prednisolone vs no steroids |
In-hospital mortality, hospital LOS |
No effect of steroids on in-hospital mortality (aOR:0.85, 95% CI: 0.39-1.88). IV steroid group had longer hospital LOS (IRR = 1.51, 95% CI = 1.37-1.66). |
Moderate |
|
| Nafae, 2013 [67] |
Egypt |
RCT |
≥18 y with CAP |
80 |
IV Hydrocortisone 200mg + infusion vs placebo |
Pao2/FiO2 ratio |
Improvement in Pao2:FiO2 ratio (365.5 ± 61.4 vs 321.5 ± 101.9), inflammatory markers (WBC, CRP, ESR), reduced hospital LOS (9.27 ± 2.4 vs 16.5 ± 2.24; P < 0.05) and deaths (6.7% vs 31.6%; P < 0.05) in adjuvant hydrocortisone vs placebo group. |
Some Concerns |
|
|
Guidelines
| |||||||||
| Annisa, 2014 [68] |
Malaysia |
Retrospective cohort |
≥18 y with CAP |
323 |
National guidelines on antibiotic use |
Hospital LOS; clinical Improvement (clinical signs and laboratory values) |
No difference in hospital LOS (4.72 vs 4.9 d, P = 0.457) or most clinical signs measured however, decreased time to resolution of tachycardia and leukocytosis in guideline-adherent vs non-adherent group (1.77 vs 2.45 d; P = 0.041) and (5.51 vs 1.16; P = 0.040). |
Serious |
|
| Silveira, 2012 [69] |
Brazil |
Retrospective cohort |
≥18 y hospitalized with CAP |
112 |
Adherence to Brazilian Thoracic Association guidelines |
30-d mortality |
No significant difference in 30-d mortality in guideline-concordant patients except for those with CRB-65 score 1-2 (P = 0.01). Non-significant difference in hospital LOS in patients in whom admission and treatment criteria were in accordance with guidelines (12d vs 16d; P = 0.066). Multivariable regression showed lower risk of death in guideline-adherent group (RR = 0.85, 95% CI = 0.76 to 0.96) |
Moderate |
|
|
Traditional Chinese Medicine
| |||||||||
| Song, 2019 [70] |
China |
RCT |
18-75 y old with severe CAP |
710 |
XueBiJing 100mL BID vs placebo |
Clinical Improvement (pneumonia severity index); 28-d mortality |
Improvement in the pneumonia severity index risk (60.78% XueBiJing vs 46.33% placebo) (between-group difference, 14.4% (95% CI = 6.9‚ 21.8%); P < 0.001). Lower 28-d mortality rate (15.87% XueBiJing vs 24.63%; P = 0.006) |
Some Concerns |
|
|
Nutrients and Minerals
| |||||||||
| Sharafi, 2016 [71] | Iran | RCT | ≥50 y wth CAP | 89 | Zinc sulphate 110mg BID vs placebo | Hospital length-of-stay | No significant difference in LOS (P = 0.18), normalization of RR (P = 0.55) and SpO2 (P = 0.26) between zinc vs placebo group (P = 0.18). | Some Concerns |
|
BID – twice daily, CI – confidence intervals, CT – computed tomography, ICU – intensive care unit, IV – intravenous, LOS – length of stay, mg – milligram, N – number of participants, PO – per oral, RoB – risk of bias, RR – respiratory rate, SpO2 – oxygen saturation, IRR – incidence rate ratio