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There was no difference between the compared antibiotics regarding treatment success (1.08, 0.91\u20131.29), microbiological success (1.04, 0.72\u20131.50) or development of adverse effects (0.81, 0.46\u20131.43). In the subset of patients with<jats:italic>Pseudomonas aeruginosa<\/jats:italic>pneumonia, carbapenems were associated with lower treatment success (0.42, 0.22\u20130.82) and lower eradication of<jats:italic>P.<\/jats:italic>strains (0.50, 0.24\u20130.89).<\/jats:p><jats:p>Carbapenems are equivalent to fluoroquinolones or \u03b2-lactams, alone or in combination with aminoglycosides, for the empirical treatment of immunocompetent adult patients with hospital-acquired pneumonia. However, there is limited evidence, based predominantly on unblinded randomised controlled trials, that carbapenems are associated with lower mortality than the comparators; this association was not observed in a subset analysis of randomised controlled trials with a high methodological quality score. 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