title: Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review.
abstract: We conducted a meta-analysis of randomised trials to evaluate the efficacy and safety of inhaled antibiotics in patients with stable non-cystic fibrosis (CF) bronchiectasis. We searched the Cochrane Airways Group Register of Trials from inception until March 2014. 12 trials with 1264 adult patients were included, of which five were unpublished studies. Eight trials on 590 patients contributed data to the meta-analysis. Amikacin, aztreonam, ciprofloxacin, gentamicin, colistin or tobramycin were used for 4 weeks to 12 months. Inhaled antibiotics were more effective than placebo or symptomatic treatment in reducing sputum bacterial load (five trials; weighted mean difference -2.65 log10 CFU · g(-1), 95% CI -4.38- -0.92 log10 CFU · g(-1)), eradicating the bacteria from sputum (six trials; risk ratio 4.2, 95% CI 1.66-10.64) and reducing the risk of acute exacerbations (five trials; risk ratio 0.72, 95% CI 0.55-0.94). Bronchospasm occurred in 10% of patients treated with inhaled antibiotics compared with 2.3% in the control group (seven trials; risk ratio 2.96, 95% CI 1.30-6.73), but the two groups had the same withdrawal rate due to adverse events (12.2%). Inhaled antibiotics may provide an effective suppressive antibiotic therapy with an acceptable safety profile in adult patients with stable non-CF bronchiectasis and chronic bronchial infection.
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil.
authors.forename: Alessandra Monteiro
authors.initials: AM
authors.lastname: Brodt
authors.affiliation: Cochrane Airway Group, Population Health Sciences and Education, St George's University of London, London, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stovold
authors.affiliation: Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil, zhanglinjie63@yahoo.com.br.
authors.forename: Linjie
authors.initials: L
authors.lastname: Zhang
mesh_terms: D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001980:Bronchi / Q000382:microbiology; D001987:Bronchiectasis / Q000188:drug therapy* / Q000382:microbiology; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D006801:Humans; D061214:Patient Safety; D011552:Pseudomonas Infections / Q000188:drug therapy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents