A Cochrane review [Abstract] 1 included 11 studies with a total of 3352 subjects (aged 12 years and older diagnosed with community-acquired pneumonia). 10 RCTs assessed nine antibiotic pairs (3321 participants) and one RCT assessed four antibiotics (31 participants) in people with CAP. There were no significant differences in outcomes. Studies evaluating clarithromycin and amoxicillin provided only descriptive data regarding the primary outcome. Though the majority of adverse events were similar between all antibiotics, nemonoxacin demonstrated higher gastrointestinal and nervous system adverse events when compared to levofloxacin, while cethromycin demonstrated significantly more nervous system side effects, especially dysgeusia, when compared to clarithromycin. Similarly, high-dose amoxicillin (1 g three times a day) was associated with higher incidence of gastritis and diarrhoea compared to clarithromycin, azithromycin and levofloxacin.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), by inconsistency (heterogeneity in interventions and outcomes) and by imprecise results (limited study size for each comparison).
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