Therapy

• second or third generation cephalosporins with a macrolide ^b
• fluoroquinilone ^b

Why?

• Elderly patients who receive second or third generation cephalosporins with a macrolide or fluoroquinilone are less likely to die ^b
• Patients who receive beta-lactam/beta-lactamase inhibitors plus macrolide or an aminoglycoside plus any other antimicrobial agent are at increased risk of dying ^b

Fluoroquinolones and second or third generation cephalosporins with a macrolide reduce mortality in the elderly

Patient	Prognostic Factor	Outcome	CER	OR (95% CI)	NNF+ (95% CI)
elderly with pneumonia b	fluroquinolones only independent	death at 30 days	25% (20% to 30%)	0.64 (0.43 to 0.94)	-20 (-130 to -12)
	second-generation cephalosporin plus macrolide independent			0.71 (0.52 to 0.96)	-25 (-190 to -15)
	non-pseudomonal third-generation cephalosporin plus macrolide independent			0.74 (0.60 to 0.92)	-29 (-95 to -18)
	beta-lactam/beta-lactamase inhibitors plus macrolide independent			1.77 (1.28 to 2.46)	11 (6 to 29)
	aminoglycoside plus any other antimicrobial agent(s) independent			1.21 (1.02 to 1.43)	38 (19 to 390)

• More patients on levofloxacin improve or are cured than ceftriaxone or cefuroxime. ^a
• Fewer patients on sparfloxacin relapse than amoxicillin. ^a

Fluroquinolones cure more patients

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
community-acquired pneumonia a	levofloxacin	ceftriaxone or cefuroxime	clinical success at 7 days	90%	-7% (-12% to -1%)	17 (9 to 73)
community-acquired pneumonia a	sparfloxacin	amoxicillin	relapse at follow-up visit	6.5%	71% (-3% to 92%)	22 (11 to 310