Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review

Brodt, Alessandra Monteiro; Stovold, Elizabeth; Zhang, Linjie

doi:10.1183/09031936.00018414

Cited by 169 publications

(131 citation statements)

References 31 publications

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“…However, the use of long-term inhaled antibiotics was associated with a higher risk of wheeze (odds ratio of 6.7) and bronchospasm (odds ratio of 2.8). Similar results were previously reported by Brodt et al, 26 suggesting that inhaled antibiotics may provide an effective suppressive antibiotic therapy. However, in contrast, they concluded that inhaled antibiotics have an acceptable profile for adult subjects with NCFB and chronic bronchial infection.…”

Section: Non-cystic Fibrosis Bronchiectasissupporting

confidence: 91%

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Aerosolized Antibiotics

2015

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Administration of medications via aerosolization is potentially an ideal strategy to treat airway diseases. This delivery method ensures high concentrations of the medication in the targeted tissues, the airways, with generally lower systemic absorption and systemic adverse effects. Aerosolized antibiotics have been tested as treatment for bacterial infections in patients with cystic fibrosis (CF), non-CF bronchiectasis (NCFB), and ventilator-associated pneumonia (VAP). The most successful application of this to date is treatment of infections in patients with CF. It has been hypothesized that similar success would be seen in NCFB and in difficult-to-treat hospital-acquired infections such as VAP. This review summarizes the available evidence supporting the use of aerosolized antibiotics and addresses the specific considerations that clinicians should recognize when prescribing an aerosolized antibiotic for patients with CF, NCFB, and VAP.

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Section: Non-cystic Fibrosis Bronchiectasissupporting

confidence: 91%

“…24 We discuss the most relevant literature regarding the clinical application of aerosolized antibiotics for patients with CF, NCFB, and VAP infected with difficult-to-treat pathogens. 4,10,[25][26][27][28][29] …”

Section: Clinical Indications For Aerosolized Antibioticsmentioning

confidence: 99%

Aerosolized Antibiotics

2015

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“…Despite heterogeneity in the testing methodology, the metaanalysis did not show a statistically significant difference in the emergence of bacterial resistance in the inhalation treatment group compared to the controls. This meta-analysis lends some support to the use of inhaled antibiotics for the treatment of chronic bacterial infections in the airways of patients with stable non-CF bronchiectasis (230). There was significant heterogeneity in this analysis, especially surrounding the duration of inhaled therapy.…”

Section: Non-cf Bronchiectasismentioning

confidence: 70%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

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SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

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“…In the primary care setting, once a specific type of ACT has been selected, the patients should be questioned about the regular use of this therapy and encouraged to be as compliant as possible. Chronic use of antibiotics, both oral and inhaled, has been used as suppressive therapy in selected patients with additional improvements in exacerbation rates, symptoms scores and quality of life markers 76, 77. These therapies should be carefully tailored based on the extent of the disease, daily symptoms and culture results.…”

Section: Diagnostic Approachmentioning

confidence: 99%

Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know

et al. 2017

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SummaryAimsNon‐cystic fibrosis bronchiectasis (NCFB) is a chronic, progressive respiratory disorder characterised by irreversibly and abnormally dilated airways, persistent cough, excessive sputum production and recurrent pulmonary infections. In the last several decades, its prevalence has increased, making it likely to be encountered in the primary care setting. The aim was to review the clinical presentation and diagnosis of NCFB, with an emphasis on the role of computed tomography (CT).MethodsFor this review, trials and reports were identified from PubMed/Medline and ClinicalTrials.gov from the US NIH and the Cochrane Register of Controlled Trials. The search used keywords: bronchiectasis, non‐cystic fibrosis bronchiectasis, chronic pulmonary infection and computed tomography. No date/language restrictions were used.ResultsNon‐cystic fibrosis bronchiectasis often coexists with other respiratory conditions, such as chronic obstructive pulmonary disease. The prevalence of NCFB is increasing, particularly in women and older individuals, possibly as a result of increased physician awareness and widespread use of CT, which is the gold standard for the diagnosis of NCFB. CT can assist in identifying an underlying cause of NCFB and determining the extent and severity of the disease.DiscussionNon‐cystic fibrosis bronchiectasis should be suspected in the primary care setting in patients with chronic cough, purulent sputum and frequent respiratory infections that tend to resolve slowly or partially. Early diagnosis and determination of the extent and severity of the disease by CT and other tests are critical to establish therapy to improve quality of life and potentially slow progressive decline of lung function in patients with NCFB .

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Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review

Cited by 169 publications

References 31 publications

Aerosolized Antibiotics

Aerosolized Antibiotics

Inhaled Antibiotics for Gram-Negative Respiratory Infections

Suspecting non-cystic fibrosis bronchiectasis: What the busy primary care clinician needs to know

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