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Background The emergence of bacterial resistance to commonly used antibiotics,such as macrolides,is complicating the management of respiratory tract infections (RTIs).Telithromycin,a ketolide antimicrobial structurally related to macrolides,is approved for the treatment of community-acquired RTIs,and shows lower pathogen resistance rates.The purpose of this study was to compare the efficacy and safety of telithromycin with clarithromycin,a macrolide routinely used as therapy for RTIs.Methods We performed a meta-analysis of relevant randomized-controlled trials (RCTs) identified in PubMed,the Cochrane Library,Embase,CNKI and VIP databases.The primary efficacy outcome was clinical treatment success assessed at the test-of-cure time in the per-protocol population,and the primary safety outcome was drug related adverse effects.Results Seven RCTs,involving 2845 patients with RTIs,were included in the meta-analysis.Oral telithromycin and clarithromycin showed a similar clinical treatment success in modified intention to treat and per-protocol population (cure and improvement) (odds ratios (ORs):0.84,95％ confidence intervals (CI):0.64-1.11 and OR:1.14,95％ CI:0.71-1.85,respectively).Similar findings were obtained for secondary efficacy outcomes:clinical treatment success at a late posttherapy visit (OR:0.92,95％ CI:0.57-1.48) and microbiological treatment success at the test-of-cure time (OR:1.14; 95％CI:0.71-1.85).The safety outcome analysis indicated telithromycin had a similar risk of drug-related adverse effect and serious adverse effect with clarithromycin.Conclusions Our findings indicate that oral telithromycin and clarithromycin have similar treatment efficacy and adverse effect.The advantages of lower antimicrobial resistance rates,once-daily short-duration dosing and reported lower healthcare costs make oral telithromycin a useful option for the empiric management of mild-to-moderate RTIs.