At least three months of antibiotic treatment reduced the number of exacerbations experienced by people with stable non-cystic fibrosis bronchiecstasis — both new flares and the average number of flares reported, a review of controlled trials into different therapies found.
But no significant changes were seen in hospitalization or mortality rates, leading the study’s authors to call for larger and longer trials in these patients.
The study, “Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies,”was published in the journal BMJ Evidence-Based Medicine.
Data from 30 randomized and controlled trials involving patients with stable bronchiecstasis that was not due to cystic fibrosis were included in the review. Antibiotic therapies were reviewed in 17 studies, with antibiotics given for long term (defined as three or more months).
Antibiotics reduced the number of patients experiencing exacerbations and the frequency of exacerbations. These results were not affected by patient age or the route of antibiotic administration.
Improvements were noted in patients’ lung health, assessed by both forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC).
But studies focusing on differences among patients treated with antibiotics relative to those given placebo showed no differences between patient hospitalizations or death rates. This led researchers to suggest that larger and longer trials are need to better assess tolerability and safety.
Diarrhea was a common side effect in patients treated with oral antibiotics, at a rate triple that of placebo. Those receiving inhaled antibiotics had more than twice the risk of bronchospasm (tightening of the muscles that line the airways, restricting airflow).
Patients treated with antibiotics long term, especially inhaled antibiotics, were about 2.5 times more likely to stop such use because of toxicity or adverse effects.
In one study, Lipitor (atorvastatin), a statin medication to lower blood cholesterol and triglycerides, found fewer non-cystic fibrosis bronchiecstasis patients either having exacerbations or having a lower average number of exacerbation events compared to placebo. Treated patients also reported improved quality of life.
Two studies looked at treatment with inhaled corticosteroids — anti-inflammatory medicines — in a total of 163 patients, but treatment showed no significant benefits compared to placebo. Studies of the mucoactive agents, rhDNAase and mannitol, also showed contrary results in terms of the therapies effect in lung function. Mucoactive agents act as modulators of airway mucus production. The quality of the evidence, however, was considered low.
Physical therapy improved patients’ quality of life, as well as pulmonary rehabilitation given as a comprehensive program focusing on patient’s education, exercise, and support.
Overall, “the number of patients with exacerbations was reduced by high-dose statin therapy and also with long-term antibiotic therapy. The frequency of exacerbations was reduced by long-term antibiotic therapy,” the researchers wrote.
“The evidence warranting most confidence is for long-term antibiotic therapy; however, there is insufficient evidence to identify the optimum agent, mode of therapy and length of treatment. Large multicentre double-blind trials are needed to address these short-term and long-term treatment strategies in bronchiectasis,” they concluded.
They also noted that the quality of the studies varied greatly, and stressed those available were way too few in number.
“At the time of this review, only 30 studies, mostly studies on adult patients, were available to guide the care of patients with this condition [non-cystic fibrosis bronchiecstasis],” the researchers wrote. “This is in comparison to a PubMed search, dated 23 November 2017, in which there were 5080 randomised controlled studies on COPD, 7533 on lung cancer and 10901 on asthma.”