Are bactericidal superior to bacteriostatic antibiotics for pneumonia treatment? Study throws light

London, UK: A recent study showed no differences in bactericidal and bacteriostatic antibiotics with regards to mortality, clinical cure rates, treatment failure, microbiological eradication, or relapse rates in pneumonia treatment. The study was published in the journal Clinical Microbiology and Infection on January 13, 2022. 

Bacterial pneumonia are tied to significant mortality and morbidity. Bactericidal antibiotics as first-line treatment for pneumonia are generally assumed to be superior to bacteriostatic antibiotics. Bactericidal antibiotics directly kill pathogens whereas bacteriostatic antimicrobial therapy halts the microganisms growth. 

Agians the above background, Naveed Saleem, University College London, London, UK, and colleagues performed a systematic review, meta-analysis, and trial sequential analysis (TSA) by searching the online databases.

Randomized controlled trials (RCTs) of bactericidal versus bacteriostatic antibiotics for ascertaining clinical superiority that consisted of adult patients having bacterial pneumonia treated with antibiotics in the community or in-hospital were included. A total of forty-three RCTs involving 10 752 patients met the eligibility criteria. 

Data on dichotomous outcomes are presented as risk ratio (RR).  For integrating RRs for generalizability of findings, a random-effects model with the generic Mantel–Haenszel method was used. The I2 method was used for assessing the magnitude of variation secondary to heterogeneity.

The primary outcome was the clinical cure rate. Secondary outcomes included all-cause mortality, microbiological eradication, treatment failure, and relapse rates. 

The researchers found that clinical cure rate (42 studies, 10 312 patients; RR: 1.02), all-cause mortality (25 studies, 8302 patients; RR: 1.07), microbiological eradication (24 studies, 2776 patients; RR: 1.00), treatment failure (31 studies, 7296 patients; RR: 0.96), and relapse rate (5 studies, 1111 patients; RR: 1.15) were similar between bactericidal and bacteriostatic antibiotic treatments.

This led to conclusion that bactericidal agents compared with bacteriostatic antibiotics for the treatment of pneumonia are not associated with any statistical difference in clinical cure rates, mortality, microbiological eradication, treatment failure, or relapse rates.

Reference:

The study titled, "Mortality and clinical cure rates for pneumonia: a systematic review, meta-analysis, and trial sequential analysis of randomized control trials comparing bactericidal and bacteriostatic antibiotic treatments," was published in the journal Clinical Microbiology and Infection.

DOI: https://doi.org/10.1016/j.cmi.2021.12.021