Prolonged antibiotics for non-cystic fibrosis purulent bronchiectasis in children and adults: A Cochrane review

Aim: Bronchiectasis, a chronic respiratory condition characterised by the abnormal dilatation of the bronchial lumen, is being diagnosed with increasing frequency. We aim to determine the effectiveness of prolonged antibiotic therapy in patients with non-cystic fibrosis bronchiectasis. Method: We searched the Cochrane Airways group specialised register in June 2013. Randomised controlled trials of adult or paediatric participants who underwent prolonged antibiotic therapy (≥ four weeks) compared to placebo or usual care was considered for inclusion. The primary outcome was exacerbations with secondary outcomes including lung function, exercise capacity, quality of life, sputum volume and purulence, bacterial colonisation, deaths and adverse events. Data was extracted by two authors. Results: 695 citations were retrieved from the search producing 14 studies (18 citations) meeting the inclusion/exclusion criteria. For the primary outcome of acute exacerbations seven parallel studies contributed to the meta-analysis reporting the 'number of participants with exacerbations at follow-up' (odds ratio 0.49; 95%CI 0.30 to 0.81; p=0.005) and three studies reported 'exacerbation rates' as continuous data (mean difference -0.96; 95%CI -1.39 to -0.53; p<0.0001), producing a statistically significant effect in favour of the intervention arm for both analyses at final follow-up (6 to 52 weeks). Conclusion: The available evidence shows some benefit in favour of prolonged antibiotic use in the treatment of bronchiectasis with reductions in exacerbations. More studies are required to assess the effectiveness of the different types of antibiotics available.