Abstract
BackgroundThe purpose of this study was to evaluate the clinical benefits and safety of the long-term use of macrolides in patients with non-cystic fibrosis (non-CF) bronchiectasis.MethodsEmbase, Pubmed, the Cochrane Library and Web of Science databases were searched from inception up to March 2014. The primary outcome was the improvement of exacerbations of bronchiectasis. Secondary endpoints included changes of microbiology, lung function, quality of life, sputum volume, adverse events and macrolide resistance.ResultsThe literature search yielded 139 studies, ten of which containing 601 patients were included in this meta-analysis. Macrolides showed a statistically-significant improvement in reducing acute exacerbations per patient during follow-up treatment (RR = 0.55, 95% CI: 0.47, 0.64, P < 0.001), increasing the number of patients free from exacerbations (OR = 2.81, 95% CI: 1.85, 4.26, P < 0.001), and prolonging time to a first exacerbation (HR = 0.38, 95% CI: 0.28, 0.53, P < 0.001). Macrolides maintenance treatment was superior to control with respect to attenuating FEV1 decline (p = 0.02), improving sputum volume (p = 0.009) and SGRQ total scores (p = 0.02), but showed a higher risk of adverse events, especially diarrhea (OR = 5.36; 95% CI: 2.06, 13.98, P = 0.0006). Eradication of pathogens was improved in the macrolide group (OR = 1.76, 95% CI: 0.91, 3.41, P = 0.09), while pathogen resistance caused by macrolides dramatically increased (OR = 16.83, 95% CI: 7.26, 38.99, P < 0.001). The new appearance of a microbiologic profile or participant withdrawal due to adverse events showed no significant differences between the two groups.ConclusionIn patients with non-CF bronchiectasis, macrolide maintenance treatment can effectively reduce frequency of exacerbations, attenuate lung function decline, decrease sputum volume, improve quality of life, but may be accompanied with increased adverse events (especially diarrhea) and pathogen resistance.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0872-5) contains supplementary material, which is available to authorized users.
Highlights
The purpose of this study was to evaluate the clinical benefits and safety of the long-term use of macrolides in patients with non-cystic fibrosis bronchiectasis
A study was excluded if (1) it presented as a review article or protocol; (2) involved patients with chronic respiratory conditions other than Non-cystic fibrosis bronchiectasis (non-CF) bronchiectasis, such as cystic fibrosis, COPD, asthma; (3) the duration of treatment was less than 8 weeks; or (4) the data could not be extracted with current mathematical methods
Of all the randomized controlled trial (RCT) included in the meta-analysis, five studies used azithromycin in the treatment group [17,18,19,24,25], two used erythromycin [16,21], one used clarithromycin [22], and two used roxithromycin [20,23]
Summary
The purpose of this study was to evaluate the clinical benefits and safety of the long-term use of macrolides in patients with non-cystic fibrosis (non-CF) bronchiectasis. Non-cystic fibrosis (non-CF) bronchiectasis is a respiratory disease characterized by persistent airway inflammation and dilation of the bronchial wall driven by various causes [1]. Macrolide antibiotics have been effectively used in the treatment of diffuse panbronchiolitis, COPD and cystic fibrosis [11,12,13,14]. It remains uncertain how well macrolides can serve in the management of non-CF bronchiectasis.
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