Effectiveness and safety of macrolides in bronchiectasis patients: a meta-analysis and systematic review.
OBJECTIVE
Macrolides has been studied as a potential therapeutic anti-inflammatory agent for bronchiectasis patients, which has used as an immunoregulation agent. However, the efficacy and safety results of macrolides across available randomized controlled trials (RCTs) are controversial. The aim of this systematic review is to evaluate the efficacy and safety of macrolides in bronchiectasis.


METHODS
RCTs of macrolides treatment for the patients of bronchiectasis published in PubMed and Cochrane Library were searched. Two authors independently extracted data and assessment the methodological quality. The primary efficacy outcome was the impact on the number of pulmonary exacerbation. Safety outcomes included adverse events and mortality.


RESULTS
Seven RCTs were found in the systematic review and six studies were included in the present meta-analysis. Macrolides treatment showed a significant reduced rate of pulmonary exacerbation (RR = 0.55, 95%CI = 0.43-0.70) compared with control groups. However, subgroup analysis failed to find any significant changes in total 46 patients (RR = 0.20, 95%CI = 0.03-1.58) for treatment not more than 3 months. The incidence rates of total adverse events showed no significant difference among the macrolides group and control groups.


CONCLUSIONS
Long-term treatment of bronchiectasis with macrolides can reduce incidence of pulmonary exacerbation, especially in the subgroup treatment 6 months or more. There was no evidence of increased adverse events with macrolides. However, to verify the best macrolides regimen, more studies based on larger sample size and stratified by ethnicity are still needed.
Erythromycin (PubChem CID 12560); Azithromycin (PubChem CID: 447043); Clarithromycin (PubChem CID: 84029); Roxithromycin (PubChem CID: 5480431).
Department of Respiratory Medicine, The First Affiliated Hospital of Anhui Medical University, 281 Jixi Road, Hefei, Anhui 230022, People's Republic of China.
Zu-Liang
ZL
Shi
Department of Hospital Infection Management, Yijishan Hospital, Wannan Medical College, 2 West Zheshan Road, Wuhu, Anhui 241001, People's Republic of China.
Hui
H
Peng
Department of Respiratory Medicine, The First Affiliated Hospital of Anhui Medical University, 281 Jixi Road, Hefei, Anhui 230022, People's Republic of China.
Xian-Wei
XW
Hu
Department of Respiratory Medicine, The First Affiliated Hospital of Anhui Medical University, 281 Jixi Road, Hefei, Anhui 230022, People's Republic of China. Electronic address: hujiegui2013@163.com.
Jie-Gui
JG
Hu
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001987:Bronchiectasis / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D018942:Macrolides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
D000893:Anti-Inflammatory Agents; D018942:Macrolides
Azithromycin; Bronchiectasis; Erythromycin; Macrolides; Pulmonary exacerbation; Roxithromycin