The efficacy and safety of inhaled antibiotics for the treatment of bronchiectasis in adults: a systematic review and meta-analysis

<b>Background:</b> Whilst use of inhaled antibiotics is the standard of care in patients with cystic fibrosis, there is limited evidence to support use of inhaled antibiotics in patients with bronchiectasis not due to cystic fibrosis. We conducted a systematic review and meta-analysis of all trials of inhaled antibiotics in adult bronchiectasis. <b>Methods:</b> Publications included for analysis were randomised controlled trials of inhaled antibiotics with a placebo or comparator in adult patients without cystic fibrosis. The inhaled antibiotics were commenced during a period of disease stability and the outcomes of each study met at least one of the pre-defined endpoints of interest. <b>Results:</b> Sixteen trials were included for analysis. The mean reduction of colony forming units per gram of sputum with inhaled antibiotics was -2.40 log units (95% CI -3.30 – -1.50, p&lt;0.00001). Inhaled antibiotics significantly reduced exacerbation frequency with a rate ratio of 0.81 (95% CI 0.68 – 0.98; p=0.03). Neither quality of life measure (Quality of Life Bronchiectasis questionnaire and St. Georges Respiratory Questionnaire) showed improvement above the minimal clinically important difference. There was no significant difference in treatment emergent adverse effects (odds ratio (OR) 0.94, 95% CI 0.68 – 1.32; p=0.7) or bronchospasm (OR 0.91, 95% CI 0.64 – 1.29; p=0.6). However, emergence of bacterial resistance was evident with inhaled antibiotics (risk ratio 2.38, 95% CI 1.86 – 3.05; p&lt;0.00001). <b>Conclusion:</b> Inhaled antibiotics are safe, reduce bacterial load and reduce exacerbations in bronchiectasis.