Bronchiectasis is a chronic respiratory disease characterized by abnormal and irreversible dilatation and distortion of the smaller airways leading to a chronic cough and sputum production, with breathlessness. Long-term macrolide antibiotic therapy may suppress bacterial infection and reduce inflammation, leading to fewer exacerbations, fewer symptoms, improved lung function, and improved quality of life. Dr.Kelly C and colleagues conducted a study to determine the impact of macrolide antibiotics in the treatment of adults and children with bronchiectasis.The researchers found that Long-term macrolide therapy may reduce the frequency of exacerbations and improve quality of life in bronchiectasis.
The researchers identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and hand searches of other sources. They also searched trial registries and reference lists of primary studies.
Randomised controlled trials (RCTs) of at least four weeks’ duration that compared macrolide antibiotics with placebo or no intervention for the long-term management of stable bronchiectasis in adults or children were included.The diagnosis of bronchiectasis in the cases was done by bronchography, plain film chest radiograph, or high-resolution computed tomography. The studies in which participants had received continuous or high-dose antibiotics immediately before enrolment or before a diagnosis of cystic fibrosis, sarcoidosis, or allergic bronchopulmonary aspergillosis were excluded. The primary outcomes were exacerbation, hospitalization, and serious adverse events.For data extraction and analysis authors used standard methodological procedures as expected by Cochrane.
The authors included 14 parallel-group RCTs and one cross-over RCT with interventions lasting from 8 weeks to 24 months. Of 11 adult studies with 690 participants, six used azithromycin, four roxithromycin, and one erythromycin. Four studies with 190 children used either azithromycin, clarithromycin, erythromycin, or roxithromycin.The authors found studies on azithromycin reported improved quality of life in adults. they did not have sufficient evidence from other macrolides to make a robust judgment on their use, and we similarly have insufficient evidence from children to draw clear conclusions.
The authors concluded that Long-term macrolide therapy may reduce the frequency of exacerbations and improve quality of life, although supporting evidence is derived mainly from studies of azithromycin, rather than other macrolides, and predominantly among adults rather than children. However, macrolides should be used with caution, as limited data indicate an associated increase in microbial resistance. Macrolides are associated with increased risk of cardiovascular death and other serious adverse events in other populations, and available data cannot exclude a similar risk among patients with bronchiectasis.