Meta‐analysis of efficacy and safety of inhaled ciprofloxacin in non‐cystic fibrosis bronchiectasis patients

Abstract Background No antibiotic therapies have been approved for reducing exacerbations and preventing disease progression in non‐cystic fibrosis bronchiectasis (NCFB) patients. Several recent clinical studies have investigated the feasibility of inhaled ciprofloxacin in NCFB, whereas the results were controversial. Aim No antibiotic therapies have been approved for reducing exacerbations and preventing disease progression in non‐cystic fibrosis bronchiectasis (NCFB) patients. Several recent clinical studies have investigated the feasibility of inhaled ciprofloxacin in NCFB, whereas the results were controversial. We conducted the present meta‐analysis to comprehensively evaluate the feasibility of inhalation of ciprofloxacin in NCFB. Methods Electrical databases Medline and Cochrane library were retrieved from inception through December 2019. Randomised controlled trials (RCT) comparing inhaled ciprofloxacin and placebo were selected. The primary outcomes were time to first exacerbation, frequency of exacerbations and the change in sputum Pseudomonas aeruginosa density. Results A total of five articles involving six RCT was finally included in the analysis. The time to first exacerbation was significantly prolonged by inhaled ciprofloxacin (hazard ratio: 0.72, 95% confidence interval (CI): 0.63–0.82), with low heterogeneity ( I 2 = 23%). Inhalation of ciprofloxacin significantly reduced frequency of exacerbations (risk ratio: 0.70, 95% CI: 0.61–0.79) and decreased density of sputum P. aeruginosa (weighted mean difference: −2.11 log 10 CFU/g, 95% CI: −2.96 to −1.27 log 10 CFU/g) compared with placebo. No significant between‐group differences in mortality, adverse events and discontinuation rate were observed. Further indirect treatment comparison showed no differences between the two types of inhaled ciprofloxacin in all outcomes of interest. Conclusions Ciprofloxacin inhalation treatment significantly prolonged the time to first exacerbation, reduced the frequency of exacerbations and decreased sputum P. aeruginosa density and was well tolerated. Ciprofloxacin inhalation is promising in the treatment of NCFB.