title: Prolonged treatment with macrolides in adult patients with non-cystic fibrosis bronchiectasis: meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Infection, resulting in chronic airway inflammation, forms the basis of bronchiectasis pathogenesis. Macrolides possess antibacterial, anti-inflammatory and immunomodulatory properties, and are used to treat patients with non-cystic fibrosis bronchiectasis (NCFB). However, the efficacy and safety of long-term treatment with macrolides in patients with bronchiectasis have been controversial. We performed a meta-analysis to assess the efficacy and safety of macrolides in adults with NCFB.
  
  
  METHODS
  We performed electronic search of several databases, including: Pubmed, EMBASE, EBSCO, SCI, and CENTRAL, and also searched references from identified articles for further consideration. Only randomized controlled trials (RCTs) comparing prolonged macrolide treatment with placebo for adult bronchiectasis were included. Data were extracted independently by two reviewers and combined using a fixed-effects model or random-effects with effect size expressed as OR or MD or SMD and 95% CIs for different situations.
  
  
  RESULTS
  834 studies were identified. Four RCTs met the inclusion criteria. Macrolide treatment significantly reduced pulmonary exacerbation (OR = 0.39, 95% CI 0.25-0.63) and improved lung function (SMD = 0.37, 95% CI 0.16-0.58) as compared to the placebo group. However, macrolide treatment did not significantly improve quality of life (MD = -1.90, 95% CI -7.01 to 3.20). With respect to the total numbers of participants who developed adverse events, there was no significant difference between the macrolides and placebo groups (OR = 0.83, 95% CI 0.50-1.39). Macrolides therapy could have increased the rate of macrolide resistance in adults with NCFB.
  
  
  CONCLUSIONS
  Macrolide maintenance therapy was effective in reducing pulmonary exacerbations, and improving lung function in adults with NCFB. However, it did not improve quality of life, and could have led to macrolide resistance.
authors.affiliation: Third People's Hospital of Chengdu, The Second Affiliated Hospital of Chengdu, Chongqing Medical University, Chengdu, China; Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China. Electronic address: zgycomeon@126.com.
authors.forename: Guang-Ying
authors.initials: GY
authors.lastname: Zhuo
authors.affiliation: Department of Respiratory Medicine, The Third People's Hospital of Chengdu, Chengdu, Sichuan 610031, China. Electronic address: hq_1919@126.com.
authors.forename: Qing
authors.initials: Q
authors.lastname: He
authors.affiliation: China Evidence-Based Medicine Centre, The Chinese Cochrane Centre, West China Hospital, Sichuan University, 610041, China. Electronic address: lixianglian2008@163.com.
authors.forename: Li
authors.initials: L
authors.lastname: Xiang-Lian
authors.affiliation: Nursing Department, West China Second University Hospital, Sichuan University, 610041, China. Electronic address: yinyanan1008@163.com.
authors.forename: Yin
authors.initials: Y
authors.lastname: Ya-Nan
authors.affiliation: Nursing Department, West China Hospital, Sichuan University, 610041, China. Electronic address: xiaote2006@126.com.
authors.forename: Feng
authors.initials: F
authors.lastname: Si-Te
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001987:Bronchiectasis / Q000188:drug therapy*; D024881:Drug Resistance, Bacterial; D006801:Humans; D018942:Macrolides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012129:Respiratory Function Tests; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides
keywords: Antibiotic resistance; Azithromycin; Bronchiectasis; Erythromycin; Macrolides