Inhaled antibiotics for treatment of adults with non-cystic fibrosis bronchiectasis: A systematic review and meta-analysis |
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| Affiliation: | 1. Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain;2. Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d''Hebron Institute of Research (VHIR), Barcelona, Spain;3. Clinical Infectious Diseases, Department of System Medicine, Tor Vergata University, Rome, Italy;4. Intensive Care Unit, Hospital Universitari de Vic, Barcelona, Spain;5. Department of Donor & Transplant Coordination, Vall d''Hebron University Hospital, Barcelona, Spain;6. Respiratory Department, Parc Taulí University Hospital, Barcelona, Spain;7. Respiratory Department, Dr. Josep Trueta University Hospital, Girona, Spain;8. Insitut d''Investigació Biomèdica de Girona (IDIBGI), Universitat de Girona, Girona, Spain;9. Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain;10. Clinical Research in the ICU, Anesthesia Department, CHU Nimes, Universite de Nimes-Montpellier, France;1. Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA;2. Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, MI, USA;1. Department of Cardiovascular Diseases-AUSL Romagna, Division of Cardiology, S. Maria delle Croci Hospital, Viale Randi 5, IT, Ravenna 48121, Italy;2. Department of Cardiology, Oslo University Hospital Ullevål, Institute of Clinical Sciences, University of Oslo, Kirkeveien 166, NO-0407 Oslo, Norway;1. Gastroenterology Unit, Department of Emergency and Organ Transplantation, (D.E.T.O.), University of Bari Aldo Moro, Policlinico University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy;2. “Frugoni” Internal Medicine Unit, Centre for Rare Diseases, Interdepartmental Centre for Hereditary Haemorrhagic Telangiectasia, Interdisciplinary Department of Medicine (D.I.M.), VascERN HHT Reference Centre, University of Bari Aldo Moro, Policlinico University Hospital, Bari, Italy;3. Interdisciplinary Department of Medicine-Radiology Unit, University of Bari Aldo Moro, Policlinico University Hospital, Bari, Italy;4. Neuroradiology Unit, Policlinico University Hospital, Bari, Italy |
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| Abstract: | BackgroundInhaled antibiotics (IA) in non-cystic fibrosis bronchiectasis (NCFB) are recommended by some clinical practice guidelines for prevention or treatment of NCFB exacerbations.MethodsWe performed a systematic review and meta-analysis to evaluate the efficacy and safety of IA use for treatment of adults with NCFB and Pseudomonas aeruginosa chronic bronchial infection. The search was performed in the Cochrane Library, PubMed, and Web of Science databases from 2000 to 2019. Studies of IA for treatment of stable or exacerbated NCFB adults (≥18 years) with P. aeruginosa infection were considered eligible. PROSPERO Registration number: CRD42019136154.ResultsTwelve trials (2476 participants) were included. IA therapy increased P. aeruginosa eradication from sputum in patients with exacerbations (OR: 3.19, 95%CI: 1.70–5.99) with similar effects on stable patients (OR: 7.22, 95%CI: 2.81–18.59), and a trend to reduced emergence of new respiratory pathogens (OR: 0.58, 95%CI: 0.28–1.18). IA achieved significant reduced exacerbation rates (RR: 0.90; 95%CI: 0.82–0.98) in stable patients, with a number needed to treat (NNT) of 59, but no significant changes in FEV1, mortality, hospitalizations or quality of life were identified. In stable patients, IA use increased antimicrobial resistance (RR: 2.10, 95%CI: 1.35–3.27) at the end of therapy, with a number needed to treat of 6.ConclusionsIA therapy achieved a statistically significant eradication of P. aeruginosa from sputum, with a 10% reduction of exacerbations in stable patients. This effect has to be balanced with significant increases in antimicrobial resistance. Our meta-analysis failed to show a significant benefit in terms of patient-centered outcomes. |
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