Treatment with the inhaled antibiotic ciprofloxacin can reduce the frequency of exacerbations, or sudden disease flare-ups, in people with bronchiectasis, a new analysis indicates.
The findings were published in the Internal Medicine Journal, in the study “Meta‐analysis of Efficacy and Safety of Inhaled Ciprofloxacin in Non‐cystic Fibrosis Bronchiectasis Patients.”
Recurrent lung infections are characteristic of bronchiectasis. In particular, infection by bacteria — most notably Pseudomonas aeruginosa — are associated with worse outcomes, such as an increased risk of hospitalization.
Antibiotics, such as ciprofloxacin, are medications that can kill bacteria. In the context of bronchiectasis, inhaled antibiotics are generally preferred over other types, such as oral antibiotics, for example, since they can have higher concentrations in the airways.
Some studies have suggested that ciprofloxacin could be beneficial in the treatment of bronchiectasis, such as in helping to prevent exacerbations, or those times when symptoms get suddenly worse. However, other studies have found contradictory results.
These conflicting reports have made it difficult for clinicians to determine the true efficacy of the inhaled antibiotic in bronchiectasis.
Now, researchers from Nanjing Medical University, in China, conducted a meta-analysis to better understand the impact of this antibiotic in people with non-cystic fibrosis bronchiectasis (NCFB). A meta-analysis is a type of study wherein researchers combine data from previously published studies for examination. Because meta-analyses include more data, they have more statistical power than any single study.
Altogether, the analysis included five studies that reported data from a total of six randomized clinical trials. Randomized trials are those in which participants are randomly assigned to a study group to receive different treatments; neither the researchers nor the participants know which patient is receiving which therapy.
The studies, published from 2013 to 2019, covered two formulations of ciprofloxacin — dry powder for inhalation (DPI) and delivery via tiny carriers called liposomes — with the duration of treatment lasting between eight and 48 weeks, or between about two months and nearly one year.
The analysis of the combined data indicated that, compared with a placebo, treatment with inhaled ciprofloxacin reduced the frequency of exacerbations by about 30%. Such treatment also significantly prolonged the time to the patients’ first recorded exacerbation, by approximately 28%.
The antibiotic treatment also reduced the amount of P. aeruginosa in patients’ lungs, based on data from three studies that directly measured the bacteria.
“Of note, the decline of Pseudomonas aeruginosa following inhaled ciprofloxacin treatment may also contribute to the reduced exacerbations, as Pseudomonas aeruginosa infection is linked to more pulmonary exacerbations,” the researchers wrote.
Ciprofloxacin treatment did not significantly alter mortality rates, compared with the placebo.
Rates of adverse events (AEs) were similar in the DPI ciprofloxacin and placebo groups, but lower (by about 6%) with liposomal ciprofloxacin than with the placebo. Discontinuation rates were similar between the antibiotic and placebo groups.
“The analysis of our study showed that ciprofloxacin inhalation was well tolerated, as reflected by the rate of any AEs and AEs related to treatment drugs,” the scientists wrote. “Taken together, ciprofloxacin inhalation is promising in NCFB treatment.”
The main limitation of this meta-analysis was the relatively small sample size, according to the scientists. They also said that the studies generally had short follow-up times, which may partially account for the lack of significance in the mortality rates. They further stressed the need for additional studies to directly compare different formulations of ciprofloxacin.