Long‐term macrolides for non‐cystic fibrosis bronchiectasis: A systematic review and meta‐analysis

Effects of long-term use of macrolides in patients with non-cystic fibrosis bronchiectasis: a meta-analysis of randomized controlled trials

“…Compared with study performed by Wu et al , our study attempt to strengthen evidence on the macrolide resistance risk [39]. To our knowledge, none of the meta-analysis evaluating this important issue until now.…”

British Thoracic Society Guideline for bronchiectasis in adults

“…192 There have been four meta-analyses which have all included these three studies together with shorter studies and/or paediatric studies. 193–196 The following consistent findings have been: a reduction in the number of patients who had at least one exacerbation (RR 0.55–0.7); small improvements in FEV 1 occurred in 2 of the three trials and was confirmed in the meta analyses; the benefit was not dependent on microbiology; quality of life results were more variable Wu et al 196 2014 in the five trials included in the meta analysis that used SGRQ a 5.4 fall in total score P=0.02, 196 but in the Guang-Ying 195 2014 meta analysis that included three studies which used SGRQ the changes were not significant 195 ); there were no significant increase in adverse events with macrolide, but GI side effects increase on macrolide (low dose erythromycin better tolerated than azithromycin), but in most cases not sufficient to lead to withdrawal; increased macrolide resistance occurs which was best studied by Serisier et al 2013 which showed a 27.7% increase on oropharyngeal streptococci resistance with erythromycin compared with 0.04% with placebo P<0.001. 192 …”

“…In a meta-analysis assessing the clinical effect of long-term macrolides in bronchiectasis, 196 two studies included reported on emergence of macrolide resistance: Altenburg et al reported that during treatment, 53 of 60 pathogens (88%) tested for sensitivity in 20 patients in the azithromycin group became macrolide resistant compared with 29 of 112 pathogens (26%) in 22 patients in the placebo group (P<0.001 by t-test). 191 Serisier et al reported erythromycin significantly increased the proportion of macrolide-resistant commensal oropharyngeal streptococci (P<0.001).…”

Causes of chronic productive cough: An approach to management

“…ABPA treatment, immunoglobulin replacement, treatment of rheumatoid arthritis or inflammatory bowel disease Monitoring of disease activity Lung function measured annually [17,18] Regular sputum cultures to determine colonising organisms and antibiotic resistance [14] Airway clearance techniques Active cycle of breathing techniques [19] Postural drainage [20] Positive expiratory pressure devices e.g. Flutter [21], Acapella [22,23] devices High frequency chest wall oscillation devices [24] Nebulised saline [25,26] Patients having 3 exacerbations per year requiring antibiotic therapy or those with <3 exacerbations but with significant morbidity should be considered for long term antibiotics [16] such as macrolides [28] inflammation, symptom burden and risk of exacerbation [60] and the lack of sensitivity of standard sputum cultures to detect them has led to increasing interest in DNA-based bacterial detection techniques [61,62]. The long term use of low dose azithromycin has demonstrated efficacy in the treatment of patients with COPD with improved quality of life measures and decreased frequency of exacerbations [63].…”