Highlights
- •IA use in stable NCFB had microbiologic benefit with 10% reduction of exacerbations.
- •IA therapy in NCFB increased antimicrobial resistance, with NNT of 6.
- •Minimal benefit in terms of patient-centered outcomes was documented.
- •Further research is required in high inflammatory phenotypes and alternative strategies.
Abstract
Background
Inhaled antibiotics (IA) in non-cystic fibrosis bronchiectasis (NCFB) are recommended
by some clinical practice guidelines for prevention or treatment of NCFB exacerbations.
Methods
We 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.
Results
Twelve 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.
Conclusions
IA 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.
Keywords
Abbreviations:
AE (Adverse Events), IA (Inhaled Antibiotics), NCFB (Non-Cystic Fibrosis Bronchiectasis), NTM (Non-Tuberculosis mycobacterium), OR (Odd Ratio), RCT (Randomized Controlled Trials), RR (Risk Ratio), SAE (Serious Adverse Events), SRMA (Systematic Review and Meta-analysis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 01, 2021
Accepted:
April 12,
2021
Received in revised form:
February 26,
2021
Received:
September 28,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
