BMJ  2007;335:1109 (1 December), doi:10.1136/bmj.39409.402894.BE

Letters

Community acquired pneumonia

Antibiotic coverage is atypical: evidence from randomised trials

The first 150 words of the full text of this article appear below.

Bjerre quotes an observational study to support the addition of antibiotics that cover atypical pathogens to the treatment of patients with community acquired pneumonia.¹ The results of randomised controlled trials dealing with this question were amassed in two recent systematic reviews and meta-analyses (one published in the BMJ), which were not quoted in the editorial.^{2 3} Our systematic review included 24 trials, which randomised 5015 patients.³ Mortality was no different in the arm that provided atypical coverage and the arm that did not (relative risk 1.13, 95% confidence interval 0.82 to 1.54). Regimens that covered atypical pathogens showed a trend towards clinical success and a significant advantage to bacteriological eradication. Both disappeared when evaluating methodologically high quality studies alone. Nearly all studies compared a β lactam with a single quinolone or macrolide, and we found no study that compared the addition of a macrolide to a β lactam drug.

We . . . [Full text of this article]

Beilinson Campus, Rabin Medical Centre, Petah-Tiqva, Israel

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