Tratamiento inhalado con colistina a largo plazo en pacientes ancianos con infección crónica por Pseudomonas aeruginosa y bronquiectasias

Huguet, Eva Tabernero; Alaña, Pilar Gil; Basañez, Ramón Alkiza; Gil, Anibal Hernández; Garay, J. Garrós; Igarza, J.L. Artola

doi:10.1016/j.regg.2014.09.005

Cited by 17 publications

(9 citation statements)

References 25 publications

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“…A total of 16 studies containing 17 trials published between 1999 and November 2019 with 2748 patients were included in this meta-analysis. 4 – 6 , 9 , 11 – 22 Patients received inhaled therapy with either antibiotics or placebo. The treatment course ranged from 4 weeks to 52 weeks.…”

Section: Resultsmentioning

confidence: 99%

Inhaled antibiotics therapy for stable non-cystic fibrosis bronchiectasis: a meta-analysis

Dai

2020

Ther Adv Respir Dis

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Background: The optimum antibiotic therapy for non-cystic fibrosis bronchiectasis (NCFB) has yet to be determined. A meta-analysis was conducted to evaluate the efficacy and safety of inhaled antibiotics in adults with stable NCFB. Methods: PubMed, EMBASE, MEDLINE and the Cochrane Central Register of Controlled Trials were searched through November 2019. Results: A total of 16 randomized controlled trials (RCTs), recruiting 2748 NCFB patients, were finally included. Inhaled antibiotics treatment significantly reduced the sputum bacterial load [standard mean difference (SMD) = –0.74, 95% CI: –1.16–0.32, p < 0.001, I2 = 68.1%], prolonged median time [hazard risk (HR) = 0.73, 95% confidence interval (CI): 0.57–0.93, p < 0.001, I2 = 53.6%] and reduced frequency [incidence rate ratio (IRR) = 0.74, 95% CI 0.63–0.87, p < 0.001, I2 = 20.5%] of exacerbations, with good tolerance. However, it failed to improve Pseudomonas aeruginosa eradication, [forced expiratory volume in 1 s (FEV1)] % predicted, quality of life questionnaire (QoL-B) and St. George’s respiratory questionnaire (SGRQ) scores, and may induce higher risk of P. aeruginosa resistance. Subgroup analysis showed Ciprofloxacin was more effective than other antibiotics in reducing bacterial load (SMD = –1.35, 95% CI: –1.85–0.85, I2 = 63.4%, p = 0.042). Conclusion: Inhaled antibiotics therapy holds great promise for stable NCFB as it is effective in reducing sputum bacterial load and the risk of acute attack, delaying disease progression, and is well tolerated. Although this study brings some constructive ideas in the field of clinical medication, further clinical trials should be carried out, particularly in solving drug-resistance and improving health-related quality of life (HRQoL), which we believe will finally provide benefits for patients suffering from bronchiectasis. The reviews of this paper are available via the supplemental material section.

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Section: Resultsmentioning

confidence: 99%

Inhaled antibiotics therapy for stable non-cystic fibrosis bronchiectasis: a meta-analysis

Dai

2020

Ther Adv Respir Dis

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“…Adverse events were similar in both study arms (total adverse events: 64% in the colistin group vs. 54% in the placebo group, p = 0.25) [108]. In another study, colistin (1 million IU twice a day for 12 months) was compared to conventional therapy in 39 patients with NCFB and chronic infection with P. aeruginosa [110]. Patients that received therapy did not experience any improvement in exacerbation rates.…”

Section: Non-cystic Fibrosis Bronchiectasismentioning

confidence: 99%

“…Notably, 25% of the patients of the treatment group stopped the therapy due to adverse effects, mainly respiratory. The discrepancies of tolerability between these two studies may be related to the age of the patients included (mean age 59.2 years vs. 77.7 years) and the duration of the study (6 months vs. 12 months) [108,110]. Future, longer duration studies with an emphasis on dose ranging are still needed to understand the potential benefits of inhaled gentamycin, aztreonam and colistin in NCFB.…”

Section: Non-cystic Fibrosis Bronchiectasismentioning

confidence: 99%

Inhaled Antibiotic Therapy in Chronic Respiratory Diseases

Maselli

Keyt

Restrepo

2017

IJMS

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The management of patients with chronic respiratory diseases affected by difficult to treat infections has become a challenge in clinical practice. Conditions such as cystic fibrosis (CF) and non-CF bronchiectasis require extensive treatment strategies to deal with multidrug resistant pathogens that include Pseudomonas aeruginosa, Methicillin-resistant Staphylococcus aureus, Burkholderia species and non-tuberculous Mycobacteria (NTM). These challenges prompted scientists to deliver antimicrobial agents through the pulmonary system by using inhaled, aerosolized or nebulized antibiotics. Subsequent research advances focused on the development of antibiotic agents able to achieve high tissue concentrations capable of reducing the bacterial load of difficult-to-treat organisms in hosts with chronic respiratory conditions. In this review, we focus on the evidence regarding the use of antibiotic therapies administered through the respiratory system via inhalation, nebulization or aerosolization, specifically in patients with chronic respiratory diseases that include CF, non-CF bronchiectasis and NTM. However, further research is required to address the potential benefits, mechanisms of action and applications of inhaled antibiotics for the management of difficult-to-treat infections in patients with chronic respiratory diseases.

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“…One small study by Tabernero et al found that inhaled colistin in the elderly was associated with a significant reduction in P. aeruginosa colonization although their study did not show any functional or clinical benefits. 42 Thirty-one percent of patients in the treatment arm had to stop therapy due to adverse effects. Haworth et al found nebulized colistin at a dose of 1 million international units BD for 6 months prolonged the time to first exacerbation in those that complied with treatment (80% doses or more).…”

Section: Treatmentmentioning

confidence: 99%

Non-cystic fibrosis bronchiectasis in the elderly: current perspectives

Quinn

Hill

2018

CIA

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Bronchiectasis is a chronic lung disease with permanently damaged airways predisposing to recurrent respiratory tract infections. There is an increasing prevalence of bronchiectasis in the elderly, affecting approximately 10 patients per 1,000 population. Studies have shown that older, frailer patients tend to have a more severe and symptomatic disease, with those aged 80 and above with worse quality of life, increased hospitalization and increased mortality. These patients will be encountered by clinicians working in all aspects of elderly care. This review covers the various investigations and aspects of treatment for bronchiectasis and how they may be utilized in a more older and generally frailer population.

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Tratamiento inhalado con colistina a largo plazo en pacientes ancianos con infección crónica por Pseudomonas aeruginosa y bronquiectasias

Cited by 17 publications

References 25 publications

Inhaled antibiotics therapy for stable non-cystic fibrosis bronchiectasis: a meta-analysis

Inhaled antibiotics therapy for stable non-cystic fibrosis bronchiectasis: a meta-analysis

Inhaled Antibiotic Therapy in Chronic Respiratory Diseases

Non-cystic fibrosis bronchiectasis in the elderly: current perspectives

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