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Long‐term macrolides for non‐cystic fibrosis bronchiectasis: A systematic review and meta‐analysis
Author(s) -
Wu Qibiao,
Shen Weixing,
Cheng Haibo,
Zhou Xiqiao
Publication year - 2014
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12233
Subject(s) - medicine , bronchiectasis , meta analysis , confidence interval , placebo , sputum , relative risk , randomized controlled trial , adverse effect , strictly standardized mean difference , gastroenterology , tuberculosis , lung , pathology , alternative medicine
Long‐term macrolides are increasingly being prescribed for stable bronchiectasis. This meta‐analysis assessed the clinical effect of this treatment in bronchiectasis. A systematic review and meta‐analysis were carried out. All randomized, controlled trials ( RCT ) comparing long‐term macrolides with placebo and/or usual medical care, with outcome measures relating to efficacy and safety were selected. Nine RCT recruiting 530 patients were included. Compared with placebo and/or usual medical care, long‐term macrolides significantly reduced the risk of the exacerbations (number of participants with exacerbations (relative risk = 0.70, 95% confidence interval ( CI ) 0.60–0.82, P < 0.00001); average exacerbations per participant (weighted mean difference = −1.01, 95% CI −1.35 to −0.67, P < 0.00001)), the S t G eorge's R espiratory Q uestionnaire total scores (weighted mean difference = −5.39 95% CI −9.89 to −0.88, P = 0.02), dyspnoea scale (weighted mean difference = −0.31 95% CI −0.42 to −0.20, P < 0.00001), 24‐h sputum volume ( P < 0.00001), and attenuated the decline of forced expiratory volume in 1 s (weighted mean difference 0.02 L , 95% CI 0.00–0.04, P = 0.01). Eradication of pathogens ( P = 0.06), overall rate of adverse events ( P = 0.61), and emergence of new pathogens ( P = 0.61) were not elevated, while gastrointestinal events increased significantly with macrolides ( P = 0.0001). Macrolide resistance increased, but a meta‐analysis was not possible due to the diversity of parameters. Long‐term use of macrolides appears to be a treatment option for stable bronchiectasis. The results of this review justify further investigation about adding this intervention to the treatment regimens of bronchiectasis.