SynthesisBMJ (Clinical research ed.)2005
Effectiveness of beta lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis.
Synthesis in BMJ (Clinical research ed.), 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
40 citing papers in PubMed, 6 syntheses or guidelines pooled it, 175 citations in OpenAlex.
- Identifying the Best Initial Oral Antibiotics for Adults with Community-Acquired Pneumonia: A Network Meta-Analysis.Journal of general internal medicine · 2024Pooled it
- Clinical failure with and without empiric atypical bacteria coverage in hospitalized adults with community-acquired pneumonia: a systematic review and meta-analysis.BMC infectious diseases · 2017Pooled it
- Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults.The Cochrane database of systematic reviews · 2012Pooled it
- Guidelines for the management of adult lower respiratory tract infections--full version.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2011Guideline
- Rapid diagnosis of pneumococcal pneumonia among HIV-infected adults with urine antigen detection.The Journal of infection · 2007Pooled it
- Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2007Guideline
- Efficacy of Bromhexine hydrochloride combined with bronchoalveolar lavage under fiberoptic bronchoscopy in the treatment of mild to moderate community-acquired pneumonia.Pakistan journal of medical sciences · 2026Article
- Reactive infectious mucocutaneous eruption secondary to Chlamydia pneumoniae infection in a 19-year-old: a case report.Access microbiology · 2026Article
- A retrospective observational cohort study of oral azithromycin treatment for Legionnaires' disease.The Journal of antimicrobial chemotherapy · 2025Observational
- The role of empiric atypical antibiotic coverage in non-severe community-acquired pneumonia.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Review
- Consumption of tetracyclines, sulphonamides and trimethoprim, and other antibacterials in the community, European Union/European Economic Area, 1997-2017.The Journal of antimicrobial chemotherapy · 2021Review
- Antibiotic Treatment of Pulmonary Infections: An Umbrella Review and Evidence Map.Frontiers in pharmacology · 2021Review
- Early Corticosteroid Therapy forJournal of clinical medicine · 2019Article
- [Twenty-five myths in infectious diseases in primary care associated with overdiagnosis and overtreatment].Atencion primaria · 2018Review
- The efficacy of high-dose penicillin G for pneumococcal pneumonia diagnosed based on initial comprehensive assessment at admission: an observational study.BMC research notes · 2018Observational
- Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia.Infection & chemotherapy · 2018Review
- Additional corticosteroids or alternative antibiotics for the treatment of macrolide-resistantKorean journal of pediatrics · 2017Article
- Atypical aetiology in patients hospitalised with community-acquired pneumonia is associated with age, gender and season; a data-analysis on four Dutch cohorts.BMC infectious diseases · 2016Article
- Antibiotic Prescriptions and Prophylaxis in Italian Children. Is It Time to Change? Data from the ARPEC Project.PloS one · 2016Article
- High-Throughput Intracellular Antimicrobial Susceptibility Testing of Legionella pneumophila.Antimicrobial agents and chemotherapy · 2015Article
Corrections and comments
- Commented on by
Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo systematically compare beta lactam antibiotics with antibiotics active against atypical pathogens in the management of community acquired pneumonia. DATA SOURCES: Medline, Embase, Cochrane register of controlled trials, international conference proceedings, drug registration authorities, and pharmaceutical companies. Review methods Double blind randomised controlled monotherapy trials comparing beta lactam antibiotics with antibiotics active against atypical pathogens in adults with community acquired pneumonia. Primary outcome was failure to achieve clinical cure or improvement.
results18 trials totalling 6749 participants were identified, with most patients having mild to moderate community acquired pneumonia. The summary relative risk for treatment failure in all cause community acquired pneumonia showed no advantage of antibiotics active against atypical pathogens over beta lactam antibiotics (0.97, 95% confidence interval 0.87 to 1.07). Subgroup analysis was undertaken in those with a specific diagnosis involving atypical pathogens. We found a significantly lower failure rate in patients with Legionella species who were treated with antibiotics active against atypical pathogens (0.40, 0.19 to 0.85). Equivalence was seen for Mycoplasma pneumoniae (0.60, 0.31 to 1.17) and Chlamydia pneumoniae (2.32, 0.67 to 8.03).
conclusionsEvidence is lacking that clinical outcomes are improved by using antibiotics active against atypical pathogens in all cause non-severe community acquired pneumonia. Although such antibiotics were superior in the management of patients later shown to have legionella related pneumonia, this pathogen was rarely responsible for pneumonia within the included trials. beta lactam agents should remain the antibiotics of initial choice in adults with non-severe community acquired pneumonia.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.