Introduction

Non-cystic fibrosis bronchiectasis (NCFBE) is a chronic and progressive disease characterized by the permanent destruction of small and mid-sized airways. Many patients are chronically colonized by Pseudomona aueruginosa, for which oral antibiotics are given. Evidence to support the use of inhaled antibiotics is contradictory.

Objective

To describe the clinical effects of inhaled Tobramycin in P. aeruginosa density in sputum and eradication, lung function, bacterial resistance, and exacerbations requiring hospital admission, in the context of patients with NCFBE colonized by P. aeruginosa.

Methods

We included RCTs comparing inhaled tobramycin to other antibiotics and placebo in patients with NCFBE.

Main findings

5 studies with 211 participants were included. 2 studies reported a significant but transitory decrease in P. aeruginosa density in sputum as compared to placebo. There was a small difference in the eradication of P. aeruginosa among groups, although with very wide confidence intervals. Tobramycin reduced the rate of hospital admissions but no frequency of exacerbations. There was no evidence of an increased rate of bacterial resistance but was associated to respiratory adverse effects.

Conclusions

Evidence is not robust enough to confirm a benefit of inhaled Tobramycin in reducing P. aeruginosa sputum density or eradication. There was a high attrition rate, in part due to respiratory adverse events after drug administration, which affects interpretation of the data and raises concerns about the tolerability of the drug. Further network meta-analysis should be done to compare the efficacy and safety of different inhaled antibiotics.

中文翻译：

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吸入妥布霉素治疗非囊性纤维化支气管扩张的铜绿假单胞菌慢性感染：系统评价和荟萃分析

介绍

非囊性纤维化支气管扩张症 (NCFBE) 是一种慢性进行性疾病，其特征是中小型气道的永久性破坏。许多患者长期被铜绿假单胞菌定植，为此需要口服抗生素。支持使用吸入性抗生素的证据是相互矛盾的。

客观的

为了描述吸入妥布霉素的临床效果在铜绿假单胞菌密度在痰和消除，肺功能，细菌性，需要住院病情加重，在患者的上下文中NCFBE定植由铜绿假单胞菌。

方法

我们纳入了在 NCFBE 患者中比较吸入妥布霉素与其他抗生素和安慰剂的 RCT。

主要发现

纳入 5 项研究，共 211 名参与者。2 项研究报告称，与安慰剂相比，痰中铜绿假单胞菌的密度显着但暂时降低。组间铜绿假单胞菌的根除率略有不同，但置信区间非常宽。妥布霉素降低了住院率，但没有恶化的频率。没有证据表明细菌耐药率增加，但与呼吸系统不良反应有关。

结论

证据不足以证实吸入妥布霉素在降低铜绿假单胞菌痰密度或根除方面的益处。损耗率很高，部分原因是给药后出现呼吸系统不良事件，这会影响数据的解释并引起对药物耐受性的担忧。应进一步进行网络荟萃分析，以比较不同吸入抗生素的疗效和安全性。