To the Editor Dr Lee and colleagues1 systematically reviewed the literature on empirical antibiotic treatment for patients with community-acquired pneumonia requiring admission to the hospital and concluded that β-lactam plus macrolide combination therapy or fluoroquinolone monotherapy is superior to β-lactam monotherapy. The authors mainly based their conclusion on observational studies, which are prone to residual confounding and usually overestimate treatment effects.2 For the comparison of β-lactam monotherapy with β-lactam plus macrolide combination therapy, the 2 high-quality trials provide evidence for the opposite conclusion.
van Werkhoven CH, Oosterheert JJ, Bonten MJM. Management of Community-Acquired Pneumonia. JAMA. 2016;316(2):221-222. doi:10.1001/jama.2016.5022