Effects of long-term use of macrolides in patients with non-cystic fibrosis bronchiectasis: a meta-analysis of randomized controlled trials

Li, Fan; Lu, Hai Wen; Wei, Ping; Ji, Xiao Bin; Liang, Shuo; Xu, Jin

doi:10.1186/s12879-015-0872-5

Cited by 48 publications

(43 citation statements)

References 43 publications

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“…We analysed whether the positive effect on reducing exacerbations was dependent on route of administration (oral or inhaled) and if on long-term oral antibiotics whether there was different efficacy if on long-term macrolide therapy or not, but this review showed no significant differences; however, there have been no head to head trials comparing inhaled antibiotics versus oral antibiotics. Similar to Fan et al ,50 there was increased diarrhoea with long-term macrolide therapy. It is well recognised that inhaled therapies can lead to chest pain, wheeze and breathlessness due to local bronchospasm.…”

Section: Discussionsupporting

confidence: 78%

Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

Dabrh

Hill

Dobler

et al. 2018

BMJ EBM

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BackgroundSeveral pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology.ObjectiveWe conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations.Study selectionMultiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model.Findings30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95% CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95% CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV1) (weighted mean difference (WMD); 0.02 (95% CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD −0.90 (95% CI −1.58 to −0.22)) and improving quality of life scores assessed by the St George’s Respiratory Questionnaire (WMD −6.07 (95% CI −10.7 to −1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy.ConclusionsModerate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.

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Section: Discussionsupporting

confidence: 78%

Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

Dabrh

Hill

Dobler

et al. 2018

BMJ EBM

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“…The use of macrolide antibiotics is associated with a comparatively low risk of Clostridium difficile infection (30), and maintenance treatment with macrolides has been suggested for patients with frequent exacerbations of chronic obstructive pulmonary disease (31), cystic fibrosis (32), and non-cystic fibrosis bronchiectasis (33). Yet for the treatment of patients with primary aldosteronism, the potential induction of pathogen resistance through antibiotic treatment or increased gastrointestinal side effects through motilide activity would not be desired.…”

Section: L168rmentioning

confidence: 99%

Macrolides selectively inhibit mutant KCNJ5 potassium channels that cause aldosterone-producing adenoma

Scholl

Abriola

Zhang

et al. 2017

Journal of Clinical Investigation

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tributed to cell maintenance. LA, UIS, and JSM designed and performed high-throughput screening assays. MP synthesized compounds. CZ and WW performed and analyzed electrophysiology. ENR performed qPCR analysis and ELISAs. UIS and BIK performed Kirby-Bauer disk-diffusion assays. UIS prepared figures and tables. UIS and RPL wrote and edited the main text and supplemental data. UIS, DH, JSM, WW, and RPL oversaw parts of the project or had advisory roles.

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“…The most studied macrolide for bronchiectasis treatment is azithromycin, for which regimens include 250 mg daily or 500 mg three days a week, but clarithromycin and erythromycin have also been used with success. 101-103 …”

Section: Pulmonary Infections In Padmentioning

confidence: 99%

Lung Disease in Primary Antibody Deficiencies

Schussler

Beasley

Maglione

2016

The Journal of Allergy and Clinical Immunology: In Practice

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Primary antibody deficiencies (PADs) are the most common form of primary immunodeficiency and predispose to severe and recurrent pulmonary infections which can result in chronic lung disease including bronchiectasis. Chronic lung disease is among the most common complications of PAD and a significant source of morbidity and mortality for these patients. However, the development of lung disease in PAD may not be solely the result of recurrent bacterial infection or a consequence of bronchiectasis. Recent characterization of monogenic immune dysregulation disorders and more extensive study of common variable immunodeficiency has demonstrated that interstitial lung disease (ILD) in PAD can result from generalized immune dysregulation and frequently occurs in the absence of pneumonia history or bronchiectasis. This distinction between bronchiectasis and ILD has important consequences in the evaluation and management of lung disease in PAD. For example, treatment of ILD in PAD typically utilizes immunomodulatory approaches in addition to immunoglobulin replacement and antibiotic prophylaxis which are the stalwarts of bronchiectasis management in these patients. Additionally, while all antibody deficient patients are at risk of developing bronchiectasis, ILD occurs in some forms of PAD much more commonly than others, suggesting that distinct but poorly understood immunological factors underlie development of this complication. Importantly, ILD can have earlier onset and may worsen survival more than bronchiectasis. Further efforts to understand the pathogenesis of lung disease in PAD will provide vital information for the most effective methods of diagnosis, surveillance, and treatment of these patients.

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Effects of long-term use of macrolides in patients with non-cystic fibrosis bronchiectasis: a meta-analysis of randomized controlled trials

Cited by 48 publications

References 43 publications

Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies

Macrolides selectively inhibit mutant KCNJ5 potassium channels that cause aldosterone-producing adenoma

Lung Disease in Primary Antibody Deficiencies

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