Novel step-by-step strategy for evaluating treatment of traditional Chinese medicine injections for community-acquired pneumonia in adults

Community-acquired pneumonia (CAP) is a leading cause of death from infectious diseases in adults worldwide. Traditional Chinese medicine injections (TCMIs) are often used as complementary therapies. This study aimed to evaluate the efficacy and safety of TCMIs for the treatment of CAP. A step-by-step strategy was first designed including data collection, systematic review, Bayesian network meta-analysis (NMA), and assessment of the NMA. Eight databases were searched for relevant randomized clinical trials (RCTs) from their inception to December 31, 2022. The Cochrane risk-of-bias tool was used to assess the methodological quality and the risk of bias of the included RCTs. Bayesian NMA was performed by WinBUGS 14.0 and STATA 15.0. Finally, the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of evidence for each outcome. A total of 35 RCTs involving 4 291 participants were included. For clinical effectiveness rate, the Reduning Injection (RDN) combined with Western medicine (WM) was the most likely to be the best treatment (SUCRA = 0.919). And the top three TCMIs interventions were RDN + WM, Xiyanping Injection (XYP) + WM, Tanreqing injection (TRQ) + WM. For defervescence time, disappearance time of cough, and the disappearance time of lung rales, the XYP with WM was probably the best treatment (SUCRA = 0.822, 0.838, 0.816). Moreover, adverse drug reactions have been reported in 14 RCTs. The TCMIs can effectively relieve clinical symptoms and improve clinical efficiency than that of WM alone for adults with non-severe CAP. Step-by-step results firstly indicated that XYP with WM was superior treatment regimen to reduce defervescence time, disappearance time of cough and disappearance time of lung rales. For safety, the mild adverse drug reactions occurred during the entire course of therapy and were self-limiting, further confirming the favorable safety profile of the TCMIs.