Antibiotics for community acquired pneumonia in adult outpatients

  • Review
  • Intervention




Community-acquired pneumonia (CAP), the sixth most common cause of death worldwide, is a common condition representing a significant disease burden for the community, particularly in the elderly. Antibiotics are helpful in treating CAP and are the standard treatment. CAP contributes significantly to antibiotic use, which is associated with the development of bacterial resistance and side-effects. Several studies have been published concerning treatment for CAP. Available data arises mainly hospitalized patients studies. This is an update of our 2004 Cochrane Review.


To summarize current evidence from randomized controlled trials (RCTs) concerning the efficacy of different antibiotic treatments for CAP in participants older than 12.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2009, issue 1) which contains the Cochrane Acute Respiratory Infections Group's Specialized Register; MEDLINE (January 1966 to February week 2, 2009), and EMBASE (January 1974 to February 2009).

Selection criteria

RCTs in which one or more antibiotics were tested for the treatment of CAP in ambulatory adolescents or adults. Studies testing one or more antibiotics and reporting the diagnostic criteria as well as the clinical outcomes achieved, were considered for inclusion.

Data collection and analysis

Two review authors (LMB, TJMV) independently assessed study reports in the first publication. In this update, LMB performed study selection, which was checked by TJMV and MMK. Study authors were contacted to resolve any ambiguities in the study reports. Data were compiled and analyzed. Differences between review authors were resolved by discussion and consensus.

Main results

Six RCTs assessing five antibiotic pairs (1857 participants aged 12 years and older diagnosed with CAP) were included. The study quality was generally good, with some differences in the extent of the reporting. A variety of clinical, radiological and bacteriological diagnostic criteria and outcomes were reported. Overall, there was no significant difference in the efficacy of the various antibiotics.

Authors' conclusions

Currently available evidence from RCTs is insufficient to make evidence-based recommendations for the choice of antibiotic to be used for the treatment of CAP in ambulatory patients. Pooling of study data was limited by the very low number of studies assessing the same antibiotic pairs. Individual study results do not reveal significant differences in efficacy between various antibiotics and antibiotic groups. Multi-drug comparisons using similar administration schedules are needed to provide the evidence necessary for practice recommendations.








我們搜尋了Cochrane Central Register of Controlled Trials (CENTRAL)(Cochrane Library 2009年第1期)﹐其中包括了在Cochrane 急性呼吸道感染組登記註冊的試驗、MEDLINE(1966年1月至2009年2月第2週)、以及EMBASE (1974年1月至2009年2月)。











此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


肺炎或肺部相關感染﹐目前排名全球死因第六位。肺炎對老人及罹患可能影響免疫系統疾病的患者(如糖尿病)尤其可能致死。抗生素是肺炎最普遍的治療方式, 其療效及副作用因藥物而異。針對社區型肺炎且未住院治療的病患﹐本篇回顧研究抗生素的效益(在院內感染肺炎,及/或是在醫院接受肺炎治療者不納入這次回顧)。使用不同抗生素治療非住院的社區型肺炎患者之試驗結果不夠多﹐無法比較療效。

Plain language summary

Antibiotics for community acquired pneumonia in adolescent and adult outpatients

Pneumonia, or infection involving the lungs, is the sixth most common cause of death worldwide. Pneumonia is especially life-threatening in older people and people with other illnesses that may affect the immune system (such as diabetes). Antibiotics are the most commonly used treatment for pneumonia, and these can vary in their effectiveness and adverse effects. This review studied the effects of antibiotics for patients with pneumonia acquired and treated in the community (as opposed to people acquiring pneumonia while in hospital, and/or being treated for pneumonia in hospital). Unfortunately, there were not enough trials to compare the effects of different antibiotics for pneumonia acquired and treated in the community.