Empiric antibiotic therapy for moderate-to-severe community-acquired pneumonia: a systematic review and network meta-analysis
Bibliographic record
Abstract
BACKGROUND: The optimal empiric antibiotic regimen for moderate-to-severe community-acquired pneumonia (CAP) is uncertain. OBJECTIVES: To compare the effects of antibiotics for empiric therapy of moderate-to-severe CAP using a network meta-analysis. DATA SOURCES: Medline, EMBASE, Cochrane CENTRAL, Web of Science, and CINAHL from inception to 03 July 2024. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCT). PARTICIPANTS: Adults with moderate-to-severe CAP. INTERVENTIONS: Any empiric antibiotic regimen vs. another, placebo, or no treatment. ASSESSMENT OF RISK OF BIAS: Paired reviewers independently assessed risk of bias using a modified Cochrane tool for assessing risk of bias in randomized trials. METHODS OF DATA SYNTHESIS: We conducted frequentist random-effect network meta-analyses addressing patient-important outcomes and assessed the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: In total, 143 RCTs involving 29,157 participants proved eligible. Effects are in comparison with respiratory fluoroquinolones alone. Penicillins alone (relative risks [RR]: 1.25, 95% CI: 0.93-1.67; risk difference [RD]: 33 more per 1000, 95% CI: 9 fewer to 88 more), second-generation cephalosporins alone (RR: 1.34, 95% CI: 0.89-2.02; RD: 45 more per 1000, 95% CI: 15 fewer to 135 more), and third-generation cephalosporins alone (RR: 1.32, 95% CI: 0.99-1.77; RD: 42 more per 1000, 95% CI: 1 fewer to 102 more) or combined with a macrolide (RR: 1.34, 95% CI: 0.98-1.84; RD: 45 more per 1000, 95% CI: 3 fewer to 111 more) may be inferior in reducing treatment failure (all low certainty). The evidence among other antibiotic regimens for treatment failure and among all regimens for all-cause mortality, duration of hospitalization, and adverse events suggested little to no difference (in most cases with low certainty) or was very low certainty. CONCLUSIONS: For empiric treatment of moderate-to-severe CAP, none of the antibiotic regimens provided convincing evidence of important differences in any of the outcomes. TRIAL REGISTRATION NUMBER: PROSPERO (CRD42022297216).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.017 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.031 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".