Prolonged antibiotic use shows beneficial effects on reducing exacerbations and hospitalizations in patients with bronchiectasis. It is thought that prolonged antibiotic use may address the vicious cycle hypothesis in bronchiectasis. A group of researchers from Flinders Medical Centre in Australia conducted a review of the literature to gather evidence and make a decision concerning the benefits of prolonged antibiotic use in bronchiectasis.
The vicious cycle in bronchiectasis describes how patients have lung infections due to damage from lung infections. When the respiratory tract is colonized with bacteria, there is an inflammatory change in the lungs. This causes damage to the mucociliary escalator, which is composed of projections covered in sticky mucus that help to move microorganisms out of the respiratory tract. The lungs are unable to clear bacteria, allowing pro-inflammatory mediators to exist and further damage the lungs’ defenses against infection.
Since some bacteria can be killed by antibiotics, antibiotics are a common treatment for bronchiectasis. However, the benefits of prolonged antibiotic therapy in bronchiectasis patients had not been explored previous to this new study, which was entitled “Prolonged Antibiotics for Non-Cystic Fibrosis Bronchiectasis in Children and Adults,” and published in The Cochrane Library.
The team of researchers conducted their literature search using the Cochrane Airways Group Trials Register and found 18 trials that appropriately treated bronchiectasis patients with prolonged antibiotics. These trials were either placebo-controlled or standard of care-controlled. In total, 1157 patients were covered in these studies.
“Prolonged antibiotics” lasted for four to 83 weeks in the studies. Although there were diverse outcomes reported in the trials, the researchers were able to compare the trials and find a benefit to prolonged antibiotic therapy. Patients treated with prolonged antibiotics experienced fewer exacerbation events than the control population experienced (271 per 1000 vs. 546 per 1000). Additionally, there were fewer hospitalizations in the prolonged antibiotic patients, although the difference was insignificant (37 in 1000 vs. 87 in 1000).
One major concern with prolonged antibiotic use is the potential for antibiotic resistance. Bacteria became resistant to drugs in 36 of 220 participants treated with prolonged antibiotics and 10 of 211 participants treated with placebo or standard therapy.
Broadly, it appears prolonged antibiotic treatment may have a place in treating bronchiectasis. Fewer exacerbations and hospitalizations are evidence that the treatment is working, and patients experience both a reduced disease burden and an enhanced quality of life. The prolonged use of antibiotics is usually cautioned against for their potential to exacerbate the emerging drug resistance of bacteria — a problem that can make bronchiectasis even more difficult to treat.