title: Antibiotic therapy for stable non-CF bronchiectasis in adults - A systematic review.
abstract: To provide an update on efficacy and safety of antibiotic treatments for stable non-cystic fibrosis (CF) bronchiectasis (BE). Systematic review based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines was done. Twenty-six studies (1.898 patients) fulfilled the inclusion criteria. Studies of inhaled tobramycin have revealed conflicting results regarding quality of life (QoL), exacerbations and admissions, but may result in sputum cultures negative for Pseudomonas aeruginosa, whereas studies investigating the effect of inhaled gentamycin have shown positive effects on sputum bacterial density, decrease in sputum cultures positive for P. aeruginosa, QoL and exacerbation rate, but no improvement in forced expiratory volume in first second (FEV1). Oral azithromycin can reduce exacerbations, together with minor improvements in QoL and FEV1. Furthermore, oral erythromycin reduces exacerbations, but has no effect on lung function, symptoms or QoL. Inhaled ciprofloxacin may reduce P. aeruginosa in sputum cultures, but without changes in lung function, exacerbations or QoL. Although with limited evidence, inhaled colistin may have effects on P. aeruginosa density, exacerbations and QoL, whereas studies on aztreonam revealed no significant clinical improvements in the outcomes of interest, including exacerbation rate. Adverse events, including bronchospasm, have been reported in association with tobramycin and aztreonam. Several antibiotic treatment regimens have been shown to improve QoL and exacerbation rate, whereas findings regarding sputum production, lung function and admissions have been conflicting. Evidence-based treatment algorithms for antibiotic treatment of stable non-CF BE will have to await large-scale, long-term controlled studies.
authors: 1 Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark.
authors: Katrine
authors: K
authors: Fjaellegaard
authors: 1 Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark.
authors: Melda Dönmez
authors: MD
authors: Sin
authors: 2 Department of Infectious Disease and Pulmonary Medicine, Nordsjællands Hospital, Hillerod, Denmark.
authors: Andrea
authors: A
authors: Browatzki
authors: 1 Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark.|3 University of Copenhagen, København, Denmark.
authors: Charlotte Suppli
authors: CS
authors: Ulrik
mesh_terms: D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001398:Aztreonam / Q000627:therapeutic use; D001987:Bronchiectasis / Q000188:drug therapy* / Q000503:physiopathology; D002939:Ciprofloxacin / Q000627:therapeutic use; D003091:Colistin / Q000627:therapeutic use; D018450:Disease Progression; D005541:Forced Expiratory Volume; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use*; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa; D011788:Quality of Life; D013183:Sputum / Q000382:microbiology
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D018942:Macrolides; D002939:Ciprofloxacin; D001398:Aztreonam; D003091:Colistin
keywords: Bronchiectasis; antibiotics; macrolides; non-CF; polymyxins; quinolones; therapy; tobramycin