Inhaled Antibiotics Therapy For Stable Non-cystic Fibrosis Bronchiectasis:A Meta-analysis

Background: Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis(NCFB)remains controversial and its clinical efficacy and safety need to be warranted.Object: We conducted a meta-analysis of randomized trials to evaluate the efficacy and safety of inhaled antibiotics in patients with stable non-cystic fibrosis bronchiectasis(NCFB).Methods: Multiple databases were searched up to November.2019.Outcomes included the number,frequency and median time of the first exacerbation,sputum bacteriology,pulmonary function parameters,health-related quality of life scores,safety and adverse events.Meta-analysis was conducted using the random effects model.Results: Sixteen randomized controlled trials recruiting 2748 NCFB patients were included in this meta-analysis.Inhaled antibiotics treatment reduced the sputum bacterial load(SMD=-0.74,95% CI:-1.16—0.32,P< 0.001,I2= 68.1%),prolonged median time(HR= 0.73,95% CI: 0.57-0.93,P< 0.001,I2= 53.6%)of exacerbations and reduced frequency(IRR= 0.74,95% CI 0.63–0.87,P< 0.001,I2= 20.5%),whereas induced higher risk of P.aeruginosa resistance(RR= 1.88,95% CI:1.46–2.42,P< 0.001,I2= 0.0%)and no improvement in achieving P.aeruginosa eradication.In addition,it had no significant effect on(FEV1)% predicted,QoL-B and SGRQ scores.Although nebulizing antibiotics were well tolerance,patients were more likely to suffer dysgeusia(RR= 3.21,95% CI: 1.22–8.43;P= 0.018,I2= 37.8%).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%,Bonferroni-adjusted p-value is 0.042),but treatment courses made no difference.Conclusion: Inhaled antibiotic treatment can significantly reduce the sputum bacterial load of patients with non-cystic fibrosis bronchiectasis(NCFB)in the stable phase,in which using Ciprofloxacin is superior to other types of antibiotic.It reduce the risk of acute attacks,however findings regarding pulmonary function or health-related quality of life(HRQoL)had been conflicting,and it accompanied with higher risk ofdrug resistance during the medication,thus failing to increase the eradication rate of sputum P.aeruginosa.