Abstract Rationale Inhaled antibiotics (IAs) improve airway bacterial control in non-cystic fibrosis bronchiectasis (NCFB) with chronic bronchial infection (CBI). Nebulized levofloxacin has shown broad antibacterial activity, but real-world evidence in NCFB is scarce. This study compared the effectiveness, safety, and resistance profile of nebulized levofloxacin versus other IAs in CBI. Methods A sub-analysis of the multicenter, retrospective INBREATHING registry included 395 patients with NCFB and CBI treated with IAs across 15 Spanish centers. Patients receiving nebulized levofloxacin (n = 81) were compared with those treated with other IAs (n = 285; mainly colistin, tobramycin, and gentamicin). Clinical data, lung function, microbiology, and adverse events were recorded. Exacerbations and hospitalizations during the year before and at 6 and 12 months after treatment initiation were compared using Wilcoxon and McNemar tests; between-group differences were analyzed with Mann-Whitney, t-test, or chi-square tests, as appropriate. Results Patients treated with levofloxacin were younger (median 68 vs. 73 years, p0.001) and more often female (66.7% vs. 51.2%, p=0.019). Pseudomonas aeruginosa was the predominant pathogen in both groups (72.8% vs. 80%). Levofloxacin was mainly prescribed as a second or third IA line, whereas other IAs were mostly first-line (72%). In the pre-post analysis, levofloxacin significantly reduced exacerbations at 6 months compared with the prior year (median 2 1-3 vs. 0 0-1; p0.001), an effect maintained at 12 months (p0.001) (Figure 1). Hospitalizations also decreased at 6 months (p=0.001). Combined exacerbations plus hospitalizations were significantly reduced at both 6 and 12 months (p0.001). Effectiveness was comparable to other Ias (Figure 1). Intolerance and overall adverse event rates were similar (19.8% vs. 20.4%). Resistance development was lower with levofloxacin (10.9% vs. 24.7%; p=0.046). Conclusions In this large real-world multicenter cohort, nebulized levofloxacin was safe, well tolerated, and associated with significant reductions in exacerbations and hospitalizations in patients with NCFB and CBI, with a lower resistance rate than other IAs. These findings support nebulized levofloxacin as an effective therapeutic option for patients with chronic bronchial infection, particularly those with frequent exacerbations or limited alternatives. Further prospective studies are warranted to confirm these results. Figure 1: Comparative analysis of exacerbation and hospitalization reduction between patients treated with nebulized levofloxacin and those treated with other IA. This abstract is funded by: Departament de Salut ; Partially funded by Chiesi Spain and Portugal, with no influence on the scientific development of the study
Gonzalez et al. (Fri,) studied this question.