Almost all over the world, β-lactam antibiotics are the drugs of choice in the treatment of mild to moderate community-acquired pneumonia. At the same time, the recommendations used in North America in recent years include the empirical prescription of antibiotics active against atypical pathogens and are supported by data obtained by P.R. Gleason et al. (USA). In a retrospective study of 12,000 cases of community-acquired pneumonia, they demonstrated a significantly higher survival rate for patients treated with fluoroquinolones or macrolides in combination with ceftriaxone / cefotaxime compared to patients treated with ceftriaxone or cefotaxime as monotherapy. However, the study design did not meet standard criteria.

The purpose of the meta-analysis by G.D. Mills et al. (New Zealand) was a comparison of the efficacy of β-lactam antibiotics and antibiotics active against atypical pathogens (fluoroquinolones, macrolides, ketolides) in the treatment of community-acquired pneumonia. The meta-analysis included the results of 18 double-blind randomized controlled trials that included 6,749 patients, most of whom suffered from mild community-acquired pneumonia. The total relative risk of therapeutic failure did not reveal any advantage of using drugs active against atypical pathogens compared to β-lactams (relative risk 0.97, 95% confidence interval 0.87-1, 07). Analysis in subgroups showed a significant decrease in the frequency of treatment failure when using antibiotics active against atypical pathogens in patients with Legionella pneumonia (75 patients, RR 0.40, 95% CI 0.19-0.85), whereas for Mycoplasma pneumoniae (311 patients, RR 0.60, 95% CI 0.31-1.17) and Chlamydia pneumoniae (115 patients, RR 2.32, 95% CI 0.67-8.03) There were no statistically significant differences.

The existing data do not allow to prove the greater effectiveness of the empirical treatment of pneumonia of community origin of mild to moderate severity with drugs active against atypical pathogens. Although the use of these antibiotics has given better results in pneumonia caused by Legionella, this pathogen is a relatively rare pathogen. Thus, β-lactam antibiotics remain the drugs of choice in the treatment of adult patients with mild to moderate community-acquired pneumonia.