title: Efficacy and safety of long-term inhaled antibiotic for patients with noncystic fibrosis bronchiectasis: a meta-analysis.
abstract: OBJECTIVE
  The evidence supported the use of nebulized antibiotics in non-cystic fibrosis (non-CF) bronchiectasis is indefinite. A meta-analysis was performed to determine the efficacy and safety of long-term inhaled antibiotics for patients with non-CF bronchiectasis.
  
  
  METHODS
  PubMed, Embase, Web of Science and Cochrane Library databases were searched up to March 20, 2014. Reduction of sputum bacterial density, eradication of sputum Pseudomonas aeruginosa, the risk of exacerbations and other clinical outcomes related to inhalation treatment were analyzed.
  
  
  RESULTS
  Three hundred seventy articles were searched. Eight randomized controlled trials recruiting 539 patients were included in this meta-analysis. Long-term inhaled antibiotics showed an obvious reduction of the sputum bacterial density [weighted mean difference = 2.85, 95% confidence interval (CI): 1.6-4.09, P < 0.00001] and augment eradication of sputum P. aeruginosa [odds ratio (OR) = 6.6, 95% CI: 2.93-14.86, P < 0.00001]. No evidences showed higher risk of P. aeruginosa resistance after inhaled therapy. In addition, nebulized therapy reduced the amount of patients with exacerbation (OR = 0.46, 95% CI: 0.21-1.00, P = 0.05). However, patients with inhaled antibiotics were more likely to suffer wheeze (OR = 6.74, 95% CI: 2.22-20.52, P = 0.0008) and bronchospasm (OR = 2.84, 95% CI: 1.11-7.25, P = 0.03).
  
  
  CONCLUSIONS
  For patients with non-CF bronchiectasis, long-term inhaled antibiotics can effectively reduce the sputum bacterial density, increase P.A eradication and attenuate the risk of exacerbation, however, accompanied with higher risk of wheeze and bronchospasm.
authors.affiliation: Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.|Department of Respiratory Medicine, Shanghai pulmonary Hospital, Soochow University, Shanghai, China.
authors.forename: Jia-Wei
authors.initials: JW
authors.lastname: Yang
authors.affiliation: Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Li-Chao
authors.initials: LC
authors.lastname: Fan
authors.affiliation: Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Hai-Wen
authors.initials: HW
authors.lastname: Lu
authors.affiliation: Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Xia-Yi
authors.initials: XY
authors.lastname: Miao
authors.affiliation: Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.|Department of Respiratory Medicine, Shanghai pulmonary Hospital, Soochow University, Shanghai, China.
authors.forename: Bei
authors.initials: B
authors.lastname: Mao
authors.affiliation: Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China. jfxucn@gmail.com.|Department of Respiratory Medicine, Shanghai pulmonary Hospital, Soochow University, Shanghai, China. jfxucn@gmail.com.
authors.forename: Jin-Fu
authors.initials: JF
authors.lastname: Xu
mesh_terms: D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001987:Bronchiectasis / Q000188:drug therapy* / Q000382:microbiology; D004334:Drug Administration Schedule; D006801:Humans; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D016032:Randomized Controlled Trials as Topic; D013183:Sputum / Q000187:drug effects / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: bronchiectasis; efficacy; inhaled antibiotic; meta-analysis; safety