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Quinolones versus macrolides in the treatment of legionellosis: a systematic review and meta-analysis.
[legionellosis]
Legionellosis
is
a
life-threatening
disease
.
The
clinical
superiority
of
quinolones
or
macrolides
for
treating
patients
with
legionellosis
has
not
been
established
.
We
performed
a
systematic
review
and
meta
-analysis
of
studies
reporting
data
that
allowed
the
comparison
of
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
treatment
group
.
Treatment
effect
was
assessed
using
a
Mantel-
Haenszel
random
effects
model
.
Among
1005
abstracts
reviewed
,
12
studies
were
selected
(
n
=
879
patients
)
.
No
randomized
controlled
trial
was
performed
directly
comparing
quinolone
and
macrolide
efficacy
in
legionellosis
.
Mean
age
was
58
.
3
years
,
27
.
7
%
were
women
and
Fine
score
was
≥
4
in
35
.
8
%
.
Among
253
patients
who
received
quinolone
monotherapy
,
10
died
(
4
.
0
%
)
.
Among
211
patients
who
received
macrolide
monotherapy
,
23
died
(
10
.
9
%
)
.
The
pooled
OR
of
death
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
(
I
(
2
)
=
0
%
for
both
,
P
=
1
)
.
Other
studied
outcomes
were
not
significantly
different
among
treatment
groups
.
Few
clinical
data
on
legionellosis
treatment
are
available
.
This
first
meta
-analysis
showed
a
trend
toward
a
lower
mortality
rate
and
a
significant
decrease
in
length
of
hospital
stay
among
patients
receiving
quinolones
.
These
results
must
be
confirmed
by
a
randomized
controlled
trial
.
Diseases
Validation
Diseases presenting
"few clinical data on legionellosis"
symptom
legionellosis
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