Abstract
Recurrent bacterial infection causes frequent bronchiectasis (BE) exacerbations. The effectiveness and safety of long-term administration of macrolides in BE remain controversial, especially in children who require minimal treatment to prevent exacerbation. We conducted this meta-analysis to determine the usefulness of long-term macrolide use in pediatric BE. We searched PubMed, Cochrane Library databases, Embase, KoreaMed, Igaku Chuo Zasshi, and Chinese National Knowledge Infrastructure databases. We identified randomized controlled trials (RCTs) which elucidated long-term macrolide treatment (≥ 4 weeks) in non-cystic fibrosis BE in children aged < 18 years. The primary outcome was frequency of acute exacerbation; secondary outcomes included changes in pulmonary function, sputum scores, and adverse events including bacterial resistance. We included four RCTs. Long-term macrolide treatment showed a significant decrease in the frequency of exacerbation (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.10–0.87), mean number of exacerbations per patient (mean difference, − 1.40; 95% CI, − 2.26 to − 0.54), and sputum purulence score (mean difference, − 0.78; 95% CI, − 1.32 to − 0.24). However, long-term macrolide treatment was accompanied by an increased carriage of azithromycin-resistant bacteria (OR, 7.13). Long-term macrolide administration prevents exacerbation of BE in children; however, there are risks of increasing antibiotic resistance. Benefits and risks should be weighed and determined on a patient-by-patient basis.
Highlights
Recurrent bacterial infection causes frequent bronchiectasis (BE) exacerbations
The macrolide long-term treatment did not increase the incidence of other adverse events (OR, 0.78; 95% confidence intervals (95% CI), 0.33–1.83) (Fig. 7B)[6]. This meta-analysis shows that long-term macrolide treatment over 3–24 months in pediatric non-cystic fibrosis BE reduces the frequency of exacerbation with a decrease in the mean number of exacerbations per patient during the macrolide treatment period
We found that long-term macrolide treatment improved the sputum purulence score; it did not affect the pulmonary function index and cytokine levels, including IL-8 and TNF-α, in the sputum and bronchoalveolar lavage (BAL) fluid
Summary
Recurrent bacterial infection causes frequent bronchiectasis (BE) exacerbations. The effectiveness and safety of long-term administration of macrolides in BE remain controversial, especially in children who require minimal treatment to prevent exacerbation. Randomized controlled trials (RCTs) of more than 4 weeks of macrolide treatment that compared with placebo or no intervention for long-term management of stable BE in infants, children, and adolescents under the age of 18 years were included in the present meta-analysis.
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