Meta-analysis of randomized controlled trials on the comparative efficacy and safety of azithromycin against other antibiotics for upper respiratory tract infections
Jpa. Ioannidis et al., Meta-analysis of randomized controlled trials on the comparative efficacy and safety of azithromycin against other antibiotics for upper respiratory tract infections, J ANTIMICRO, 48(5), 2001, pp. 677-689
We carried out a meta-analysis of randomized controlled trials comparing 3-
5 days of azithromycin with other antibiotics that are typically given in l
onger courses for the treatment of upper respiratory tract infections. For
acute otitis media (19 comparisons including 3421 patients), acute sinusiti
s (11 comparisons including 1742 patients) and acute pharyngitis (16 compar
isons including 2447 patients), azithromycin had similar clinical failure r
ates to the other antibiotics [random effects odds ratios 1.12, 95% confide
nce interval (Cl) 0.81-1.54; 0.91, 95% Cl 0.60-1.39; and 1.07, 95% Cl 0.59-
1.94, respectively]. The difference in clinical failures was <0.5%, and no
95% Cis exceeded 2.0%. There was no heterogeneity between studies. Subtle d
ifferences between comparators could have been due to chance. There were no
significant differences in bacteriological outcomes. Azithromycin was disc
ontinued because of adverse events in only 37 of 4870 (0.8%) patients. Shor
t courses of azithromycin are as effective as longer courses of other antib
iotics for upper respiratory tract infections. Convenience of dosing should
be balanced against the increased cost of this regimen for the treatment o
f these common infections, where often no antibiotic may be indicated at al
l.