Researchers have 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.
12 trials with 1264 adult patients were included, of which five were unpublished studies.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-cystic fibrosis bronchiectasis and chronic bronchial infection. ( Xagena )
Brodt AM et al, Eur Respir J 2014;44:382-393