背景:国际支气管扩张指南有条件地推荐吸入抗生素治疗支气管扩张患者,但个别研究结果不一致。先前的荟萃分析显示,关于吸入抗生素在支气管扩张中的疗效和安全性,有希望的结果。随后的出版物进一步补充了这一领域的现有证据。
目的:吸入性抗生素在多大程度上显示出作为支气管扩张成人治疗方案的有效性和安全性?
方法:吸入性抗生素用于支气管扩张成人患者的随机对照试验的系统评价和荟萃分析。我们搜索了MEDLINE,Embase,Cochrane中央受控试验登记册,WebofScience,和ClinicalTrials.gov进行符合条件的研究。如果他们招募了通过CT诊断为支气管扩张的成年人,并且试验的治疗持续时间至少为4周,则纳入研究。主要终点是加重频率,其他关键疗效终点包括严重加重,细菌负荷,症状,生活质量和FEV1。通过随机效应荟萃分析汇总数据。
结果:纳入了20项研究,涉及3468例患者。吸入抗生素与急性加重患者数量减少相关(风险比0.8595CI0.75-0.96),恶化频率略有降低(比率0.7895CI0.68-0.91),严重加重的频率可能减少(比率为0.4895CI0.31-0.74),首次加重的时间可能略有增加(风险比0.8095CI0.68-0.94).吸入抗生素可能导致生活质量-支气管扩张呼吸症状评分略有增加(2.51,95CI0.44至4.31),并可能降低圣乔治呼吸问卷的评分(-3.13,95CI-5.93至-0.32)。细菌负荷持续减少,但FEV1没有随着治疗而改变。证据表明两组之间的不良反应几乎没有差异(比值比0.9995CI0.75-1.30)。抗生素抗性生物可能通过治疗而增加。
结论:吸入抗生素可轻微减少急性加重,在患有支气管扩张症的成人患者中,严重恶化的可能减少,症状和生活质量可能略有改善。
背景:系统评价登记号PROSPEROCRD42023384694。
BACKGROUND: Inhaled antibiotics are recommended conditionally by international
bronchiectasis guidelines for the treatment of patients with
bronchiectasis, but results of individual studies are inconsistent. A previous meta-analysis demonstrated promising results regarding the efficacy and safety of inhaled antibiotics in bronchiectasis. Subsequent publications have supplemented the existing body of evidence further in this area.
OBJECTIVE: To what extent do inhaled antibiotics demonstrate both efficacy and safety as a treatment option for adults with bronchiectasis?.
METHODS: Systematic
review and meta-analysis of randomized controlled trials of inhaled antibiotics in adult patients with
bronchiectasis. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov for eligible studies. Studies were included if they enrolled adults with bronchiectasis diagnosed by CT imaging and had a treatment duration of at least 4 weeks. The primary end point was exacerbation frequency, with additional key efficacy end points including severe exacerbations, bacterial load, symptoms, quality of life, and FEV1. Data were pooled through random-effects meta-analysis.
RESULTS: Twenty studies involving 3,468 patients were included. Inhaled antibiotics were associated with reduced number of patients with exacerbations (risk ratio, 0.85; 95% CI, 0.75-0.96), a slight reduction in exacerbation frequency (rate ratio [RR], 0.78; 95% CI, 0.68-0.91), a probable reduction in the frequency of severe exacerbations (RR, 0.48; 95% CI, 0.31-0.74), and a likely slight increase in time to first exacerbation (hazard ratio, 0.80; 95% CI, 0.68-0.94). Inhaled antibiotics likely lead to a slight increase in the Quality of Life-
Bronchiectasis respiratory symptom score (2.51; 95% CI, 0.44-4.31) and may reduce scores on the St. George\'s Respiratory Questionnaire (-3.13; 95% CI, -5.93 to -0.32). Bacterial load consistently was reduced, but FEV1 was not changed with treatment. Evidence suggests little to no difference in adverse effects between groups (OR, 0.99; 95% CI, 0.75-1.30). Antibiotic-resistant organisms likely were increased by treatment.
CONCLUSIONS: Inhaled antibiotics result in a slight reduction in exacerbations, a probable reduction in severe exacerbations, and a likely slight improvement in symptoms and quality of life in adults with bronchiectasis.
BACKGROUND: International Prospective Register of Systematic Reviews; No.: CRD42023384694; URL: https://www.crd.york.ac.uk/prospero/.