Quinolones versus macrolides in the treatment of legionellosis: A systematic review and meta-analysis

Abstract

Background: Legionellosis is a life-threatening disease. The clinical superiority of quinolones or macrolides fortreating patients with legionellosis has not been established.Methods: We performed a systematic review and meta-analysis of studies reporting data that allowed the comparisonof quinolones versus macrolides in the treatment of proven legionellosis published from 1 January 1985 to 31 January 2013. We collected baseline aggregate patient characteristics. Studied outcomes included mortality, clinical cure, time to apyrexia, length of hospital stay and occurrence of complications in each treatmentgroup. Treatment effect was assessed using a Mantel-Haenszel random effects model.Results: Among 1005 abstracts reviewed, 12 studies were selected (n=879 patients). No randomized controlledtrialwas performed directly comparing quinolone andmacrolide efficacy in legionellosis.Mean agewas 58.3 years, 27.7% were women and Fine score was ≥4 in 35.8%. Among 253 patients who received quinolonemonotherapy, 10 died (4.0%). Among 211 patients who received macrolide monotherapy, 23 died (10.9%). The pooled OR ofdeath for treatment with a quinolone versus a macrolide was 0.5 (95% CI 0.2-1.3, n=8 studies, 464 patients).Length of stay was significantly shorter in the quinolone monotherapy group. The difference was 3.0 days (95%CI 0.7-5.3, P=0.001, n=3 studies, 263 patients). Neither of two tests for heterogeneity was significant (I2=0%for both, P=1). Other studied outcomes were not significantly different among treatment groups.Conclusions: Few clinical data on legionellosis treatment are available. This first meta-analysis showed a trendtoward a lower mortality rate and a significant decrease in length of hospital stay among patients receivingquinolones. These results must be confirmed by a randomized controlled trial. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.