Macrolide antibiotics for bronchiectasis.

Abstract:

BACKGROUND:Bronchiectasis is a chronic respiratory disease characterised by abnormal and irreversible dilatation and distortion of the smaller airways. Bacterial colonisation of the damaged airways leads to chronic cough and sputum production, often with breathlessness and further structural damage to the airways. Long-term macrolide antibiotic therapy may suppress bacterial infection and reduce inflammation, leading to fewer exacerbations, fewer symptoms, improved lung function, and improved quality of life. Further evidence is required on the efficacy of macrolides in terms of specific bacterial eradication and the extent of antibiotic resistance. OBJECTIVES:To determine the impact of macrolide antibiotics in the treatment of adults and children with bronchiectasis. SEARCH METHODS:We identified trials from the Cochrane Airways Trials Register, which contains studies identified through multiple electronic searches and handsearches of other sources. We also searched trial registries and reference lists of primary studies. We conducted all searches on 18 January 2018. SELECTION CRITERIA:We included randomised controlled trials (RCTs) of at least four weeks' duration that compared macrolide antibiotics with placebo or no intervention for the long-term management of stable bronchiectasis in adults or children with a diagnosis of bronchiectasis by bronchography, plain film chest radiograph, or high-resolution computed tomography. We excluded studies in which participants had received continuous or high-dose antibiotics immediately before enrolment or before a diagnosis of cystic fibrosis, sarcoidosis, or allergic bronchopulmonary aspergillosis. Our primary outcomes were exacerbation, hospitalisation, and serious adverse events. DATA COLLECTION AND ANALYSIS:Two review authors independently screened the titles and abstracts of 103 records. We independently screened the full text of 40 study reports and included 15 trials from 30 reports. Two review authors independently extracted outcome data and assessed risk of bias for each study. We analysed dichotomous data as odds ratios (ORs) and continuous data as mean differences (MDs) or standardised mean differences (SMDs). We used standard methodological procedures as expected by Cochrane. MAIN RESULTS:We included 14 parallel-group RCTs and one cross-over RCT with interventions lasting from 8 weeks to 24 months. Of 11 adult studies with 690 participants, six used azithromycin, four roxithromycin, and one erythromycin. Four studies with 190 children used either azithromycin, clarithromycin, erythromycin, or roxithromycin.We included nine adult studies in our comparison between macrolides and placebo and two in our comparison with no intervention. We included one study with children in our comparison between macrolides and placebo and one in our comparison with no intervention.In adults, macrolides reduced exacerbation frequency to a greater extent than placebo (OR 0.34, 95% confidence interval (CI) 0.22 to 0.54; 341 participants; three studies; I2 = 65%; moderate-quality evidence). This translates to a number needed to treat for an additional beneficial outcome of 4 (95% CI 3 to 8). Data show no differences in exacerbation frequency between use of macrolides (OR 0.31, 95% CI 0.08 to 1.15; 43 participants; one study; moderate-quality evidence) and no intervention. Macrolides were also associated with a significantly better quality of life compared with placebo (MD -8.90, 95% CI -13.13 to -4.67; 68 participants; one study; moderate-quality evidence). We found no evidence of a reduction in hospitalisations (OR 0.56, 95% CI 0.19 to 1.62; 151 participants; two studies; I2 = 0%; low-quality evidence), in the number of participants with serious adverse events, including pneumonia, respiratory and non-respiratory infections, haemoptysis, and gastroenteritis (OR 0.49, 95% CI 0.20 to 1.23; 326 participants; three studies; I2 = 0%; low-quality evidence), or in the number experiencing adverse events (OR 0.83, 95% CI 0.51 to 1.35; 435 participants; five studies; I2 = 28%) in adults with macrolides compared with placebo.In children, there were no differences in exacerbation frequency (OR 0.40, 95% CI 0.11 to 1.41; 89 children; one study; low-quality evidence); hospitalisations (OR 0.28, 95% CI 0.07 to 1.11; 89 children; one study; low-quality evidence), serious adverse events, defined within the study as exacerbations of bronchiectasis or investigations related to bronchiectasis (OR 0.43, 95% CI 0.17 to 1.05; 89 children; one study; low-quality evidence), or adverse events (OR 0.78, 95% CI 0.33 to 1.83; 89 children; one study), in those receiving macrolides compared to placebo. The same study reported an increase in macrolide-resistant bacteria (OR 7.13, 95% CI 2.13 to 23.79; 89 children; one study), an increase in resistance to Streptococcus pneumoniae (OR 13.20, 95% CI 1.61 to 108.19; 89 children; one study), and an increase in resistance to Staphylococcus aureus (OR 4.16, 95% CI 1.06 to 16.32; 89 children; one study) with macrolides compared with placebo. Quality of life was not reported in the studies with children. AUTHORS' CONCLUSIONS:Long-term macrolide therapy may reduce the frequency of exacerbations and improve quality of life, although supporting evidence is derived mainly from studies of azithromycin, rather than other macrolides, and predominantly among adults rather than children. However, macrolides should be used with caution, as limited data indicate an associated increase in microbial resistance. Macrolides are associated with increased risk of cardiovascular death and other serious adverse events in other populations, and available data cannot exclude a similar risk among patients with bronchiectasis.

authors

Kelly C,Chalmers JD,Crossingham I,Relph N,Felix LM,Evans DJ,Milan SJ,Spencer S

doi

10.1002/14651858.CD012406.pub2

subject

Has Abstract

pub_date

2018-03-15 00:00:00

pages

CD012406

issn

1469-493X

journal_volume

3

pub_type

杂志文章,meta分析,评审
  • Lithium for schizophrenia.

    abstract:BACKGROUND:Many people with schizophrenia do not achieve a satisfactory treatment response with ordinary antipsychotic drug treatment. In these cases, various add-on medications are used, among them lithium. OBJECTIVES:To review the effects of lithium for the treatment of schizophrenia and schizophrenia-like psychoses...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003834

    authors: Leucht S,McGrath J,Kissling W

    更新日期:2003-01-01 00:00:00

  • Acetylcholinesterase inhibitor treatment for myasthenia gravis.

    abstract:BACKGROUND:In myasthenia gravis, antibody-mediated blockade of acetylcholine receptors at the neuromuscular junction abolishes the naturally occurring 'safety factor' of synaptic transmission. Acetylcholinesterase inhibitors provide temporary symptomatic treatment of muscle weakness, but there is controversy about thei...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD006986.pub2

    authors: Mehndiratta MM,Pandey S,Kuntzer T

    更新日期:2011-02-16 00:00:00

  • Pharmacotherapy for trichotillomania.

    abstract:BACKGROUND:Trichotillomania (TTM) (hair-pulling disorder) is a prevalent and disabling disorder characterised by recurrent hair-pulling. The effect of medication on trichotillomania has not been systematically evaluated. OBJECTIVES:To assess the effects of medication for trichotillomania in adults compared with placeb...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007662.pub2

    authors: Rothbart R,Amos T,Siegfried N,Ipser JC,Fineberg N,Chamberlain SR,Stein DJ

    更新日期:2013-11-08 00:00:00

  • Screening programmes for the early detection and prevention of oral cancer.

    abstract:BACKGROUND:Oral cancer is an important global healthcare problem, its incidence is increasing and late-stage presentation is common. Screening programmes have been introduced for a number of major cancers and have proved effective in their early detection. Given the high morbidity and mortality rates associated with or...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004150.pub3

    authors: Brocklehurst P,Kujan O,Glenny AM,Oliver R,Sloan P,Ogden G,Shepherd S

    更新日期:2010-11-10 00:00:00

  • Photodynamic therapy for neovascular age-related macular degeneration.

    abstract:BACKGROUND:In neovascular age-related macular degeneration, new vessels grow under the retina, distorting vision and leading to scarring. This is further exacerbated if the blood vessels leak. Photodynamic therapy, originally used in cancer treatment, has been investigated as a way to treat the neovascular membranes wi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002030

    authors: Wormald R,Evans J,Smeeth L,Henshaw K

    更新日期:2003-01-01 00:00:00

  • Fewer-than-four ports versus four ports for laparoscopic cholecystectomy.

    abstract:BACKGROUND:Traditionally, laparoscopic cholecystectomy is performed using two 10-mm ports and two 5-mm ports. Recently, a reduction in the number of ports has been suggested as a modification of the standard technique with a view to decreasing pain and improving cosmesis. The safety and effectiveness of using fewer-tha...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007109.pub2

    authors: Gurusamy KS,Vaughan J,Rossi M,Davidson BR

    更新日期:2014-02-20 00:00:00

  • Respite care for people with dementia and their carers.

    abstract:BACKGROUND:Caring for someone with dementia can be emotionally and physically demanding. Respite care is any intervention designed to give rest or relief to caregivers. It is not clear what positive and negative effects the provision of respite care may have on people with dementia and their caregivers. OBJECTIVES:To ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004396.pub2

    authors: Lee H,Cameron M

    更新日期:2004-01-01 00:00:00

  • Drugs for treating neurocysticercosis (tapeworm infection of the brain).

    abstract:BACKGROUND:Anthelminthic drugs may shrink brain cysts in neurocysticercosis, but can also cause severe adverse effects. OBJECTIVES:The objective of this review was to assess the effects of drug treatment in human neurocysticercosis in relation to survival, cyst persistence, subsequent seizures and hydrocephalus. SEAR...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000215

    authors: Salinas R,Prasad K

    更新日期:2000-01-01 00:00:00

  • Antibiotics for the common cold.

    abstract:BACKGROUND:The common cold is considered to be caused by viruses and it has long been believed that antibiotics have no role in treating this condition. In many countries doctors will often prescribe antibiotics for the common cold in the belief that they may prevent secondary bacterial infection and in some cases to r...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000247

    authors: Arroll B,Kenealy T

    更新日期:2002-01-01 00:00:00

  • Information provision for stroke patients and their caregivers.

    abstract:BACKGROUND:Research shows that stroke patients and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues. OBJECTIVES:To assess the effectiveness of information provision strategies in improving the outcome for stroke patients or their identified car...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001919.pub3

    authors: Forster A,Brown L,Smith J,House A,Knapp P,Wright JJ,Young J

    更新日期:2012-11-14 00:00:00

  • Ziprasidone for schizophrenia and severe mental illness.

    abstract:BACKGROUND:Typical antipsychotic drugs are widely used as the first line treatment for people with schizophrenia. However, the atypical class of antipsychotic drugs are making important inroads into this approach. Atypical is a widely used term used to describe some antipsychotics which have a low propensity to produce...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001945

    authors: Bagnall A,Lewis RA,Leitner ML,Kleijnen J

    更新日期:2000-01-01 00:00:00

  • Withdrawal versus continuation of long-term antipsychotic drug use for behavioural and psychological symptoms in older people with dementia.

    abstract:BACKGROUND:Antipsychotic agents are often used to treat neuropsychiatric symptoms (NPS) in people with dementia although there is uncertainty about the effectiveness of their long-term use for this indication and concern that they may cause harm, including higher mortality. When behavioural strategies have failed and t...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007726.pub3

    authors: Van Leeuwen E,Petrovic M,van Driel ML,De Sutter AI,Vander Stichele R,Declercq T,Christiaens T

    更新日期:2018-03-30 00:00:00

  • Antibiotics for treating osteomyelitis in people with sickle cell disease.

    abstract:BACKGROUND:Osteomyelitis (both acute and chronic) is one of the most common infectious complications in people with sickle cell disease. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007175.pub3

    authors: Martí-Carvajal AJ,Agreda-Pérez LH

    更新日期:2012-12-12 00:00:00

  • Interleukin-1 inhibitors for acute gout.

    abstract:BACKGROUND:Acute gout flares cause significant pain and disability and it is important to provide quick and effective pain relief. Traditional options for managing acute flares include colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. OBJECTIVES:To assess the benefits and harms of interle...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD009993.pub2

    authors: Sivera F,Wechalekar MD,Andrés M,Buchbinder R,Carmona L

    更新日期:2014-09-01 00:00:00

  • Chinese herbal medicines for induction of remission in advanced or late gastric cancer.

    abstract:BACKGROUND:Gastric cancer is difficult to cure once it progresses into an advanced or late stage. Although some chemotherapies or bio-therapies have made progress in the remission of this disease, mortality remains high. A variety of Chinese medicinal herbs have been used to treat gastric cancer. OBJECTIVES:To assess ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005096.pub2

    authors: Gan T,Wu Z,Tian L,Wang Y

    更新日期:2010-01-20 00:00:00

  • Intensity of exercise for the treatment of osteoarthritis.

    abstract:BACKGROUND:Therapeutic exercise is used as one modality to treat people with osteoarthritis (OA). OBJECTIVES:To evaluate the effectiveness of therapeutic exercise of differing intensities on objective and subjective measures of disease activity in people with OA. SEARCH STRATEGY:We searched MEDLINE, EMBASE, Pedro, Cu...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD004259

    authors: Brosseau L,MacLeay L,Robinson V,Wells G,Tugwell P

    更新日期:2003-01-01 00:00:00

  • Preoperative bathing or showering with skin antiseptics to prevent surgical site infection.

    abstract:BACKGROUND:Surgical site infections (SSIs) are wound infections that occur after invasive (surgical) procedures. Preoperative bathing or showering with an antiseptic skin wash product is a well-accepted procedure for reducing skin bacteria (microflora). It is less clear whether reducing skin microflora leads to a lower...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004985.pub4

    authors: Webster J,Osborne S

    更新日期:2012-09-12 00:00:00

  • Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus.

    abstract:BACKGROUND:Idiopathic sudden sensorineural hearing loss (ISSHL) with or without tinnitus is common and presents a health problem with significant effect on quality of life. Hyperbaric oxygen therapy (HBOT) may improve oxygen supply to the inner ear and, it is postulated, may result in an improvement in hearing and/or a...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004739.pub3

    authors: Bennett MH,Kertesz T,Yeung P

    更新日期:2007-01-24 00:00:00

  • Interventions for preventing bone disease in kidney transplant recipients.

    abstract:BACKGROUND:Patients with chronic kidney disease have significant abnormalities of bone remodelling and calcium homeostasis and are at increased risk of fracture. The fracture risk for a kidney transplant recipient is four times that of the general population and higher than that for a patient on dialysis. Trials report...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005015.pub2

    authors: Palmer S,McGregor DO,Strippoli GF

    更新日期:2005-04-18 00:00:00

  • Neuromuscular paralysis for newborn infants receiving mechanical ventilation.

    abstract:BACKGROUND:Ventilated newborn infants breathing in asynchrony with the ventilator are at risk for complications during mechanical ventilation, such as pneumothorax or intraventricular hemorrhage, and are exposed to more severe barotrauma, which consequently could impair their clinical outcome. Neuromuscular paralysis, ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002773

    authors: Cools F,Offringa M

    更新日期:2000-01-01 00:00:00

  • Zonisamide add-on therapy for focal epilepsy.

    abstract:BACKGROUND:The majority of people with epilepsy have a good prognosis, and their seizures can be well controlled with the use of a single antiepileptic agent, but up to 30% develop refractory epilepsy, especially those with focal seizures. In this review, we summarised the evidence from randomised controlled trials (RC...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD001416.pub4

    authors: Brigo F,Lattanzi S,Igwe SC,Behzadifar M,Bragazzi NL

    更新日期:2018-10-18 00:00:00

  • Heated, humidified air for the common cold.

    abstract:BACKGROUND:Heated, humidified air has long been used by sufferers of the common cold. The theoretical basis is that steam may help congested mucus drain better and heat may destroy the cold virus as it does in vitro. OBJECTIVES:To assess the effects of inhaling heated water vapour (steam) in the treatment of the commo...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001728.pub4

    authors: Singh M,Singh M

    更新日期:2011-05-11 00:00:00

  • Vitamin supplementation for preventing miscarriage.

    abstract:BACKGROUND:Miscarriage is a common complication of pregnancy that can be caused by a wide range of factors. Poor dietary intake of vitamins has been associated with an increased risk of miscarriage, therefore supplementing women with vitamins either prior to or in early pregnancy may help prevent miscarriage. OBJECTIV...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004073.pub3

    authors: Rumbold A,Middleton P,Pan N,Crowther CA

    更新日期:2011-01-19 00:00:00

  • Exercise therapy for patellofemoral pain syndrome.

    abstract:BACKGROUND:Patellofemoral pain syndrome (PFPS) is a common problem among adolescents and young adults, characterised by retropatellar pain (behind the kneecap) or peripatellar pain (around the kneecap) when ascending or descending stairs, squatting or sitting with flexed knees. Etiology, structures causing the pain and...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003472

    authors: Heintjes E,Berger MY,Bierma-Zeinstra SM,Bernsen RM,Verhaar JA,Koes BW

    更新日期:2003-01-01 00:00:00

  • Perioperative transversus abdominis plane (TAP) blocks for analgesia after abdominal surgery.

    abstract:BACKGROUND:The transversus abdominis plane (TAP) block is a peripheral nerve block which anaesthetises the abdominal wall. The increasing use of TAP block, as a form of pain relief after abdominal surgery warrants evaluation of its effectiveness as an adjunctive technique to routine care and, when compared with other a...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007705.pub2

    authors: Charlton S,Cyna AM,Middleton P,Griffiths JD

    更新日期:2010-12-08 00:00:00

  • Interventions for managing relapse of the lower front teeth after orthodontic treatment.

    abstract:BACKGROUND:Orthodontic relapse can be defined as the tendency for teeth to return to their pre-treatment position, and this occurs especially in lower front teeth (lower canines and lower incisors). Retention, to maintain the position of corrected teeth, has become one of the most important phases of orthodontic treatm...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD008734.pub2

    authors: Yu Y,Sun J,Lai W,Wu T,Koshy S,Shi Z

    更新日期:2013-09-06 00:00:00

  • Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica.

    abstract:BACKGROUND:Acute low-back pain (LBP) is a common reason to consult a general practitioner. Debate continues on the comparative effectiveness of advice on bed rest and staying active as part of the primary care management. OBJECTIVES:To determine the effects of advice to rest in bed or stay active for patients with acu...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD007612.pub2

    authors: Dahm KT,Brurberg KG,Jamtvedt G,Hagen KB

    更新日期:2010-06-16 00:00:00

  • Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.

    abstract:BACKGROUND:Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extr...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD005506.pub2

    authors: Alhashimi D,Alhashimi H,Fedorowicz Z

    更新日期:2006-07-19 00:00:00

  • Traditional corticosteroids for induction of remission in Crohn's disease.

    abstract:BACKGROUND:Historically, corticosteroids have been the most commonly used class of medication for induction of remission in Crohn's disease (CD). Corticosteroids down regulate production of inflammatory cytokines and interfere with NF-kappaB production, thereby blunting inflammatory response. OBJECTIVES:The primary ob...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD006792.pub2

    authors: Benchimol EI,Seow CH,Steinhart AH,Griffiths AM

    更新日期:2008-04-16 00:00:00

  • Pharmacological interventions for clozapine-induced hypersalivation.

    abstract:BACKGROUND:Clozapine is widely used for people with schizophrenia. Although agranulocytosis, weight gain, and cardiac problems are serious problems associated with its use, hypersalivation, sometimes of a gross and socially unacceptable quantity, is also common (30-80%). OBJECTIVES:To determine the clinical effects of...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD005579.pub2

    authors: Syed R,Au K,Cahill C,Duggan L,He Y,Udu V,Xia J

    更新日期:2008-07-16 00:00:00