The effect of additional antimicrobial agents on the clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) is unclear. We performed comprehensive searches of randomized control trials (RCTs) that compared the clinical efficacy of additional antimicrobial agents to those of placebo or usual care in the treatment of IPF patients. The primary outcome was all-cause mortality, and the secondary outcomes were changes in forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), and the risk of adverse events (AEs). Four RCTs including a total of 1055 patients (528 receiving additional antibiotics and 527 receiving placebo or usual care) were included in this meta-analysis. Among the study group, 402 and 126 patients received co-trimoxazole and doxycycline, respectively. The all-cause mortality rates were 15.0% (79/528) and 14.0% (74/527) in the patients who did and did not receive additional antibiotics, respectively (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.76 to 1.51; p = 0.71). No significant difference was observed in the changes in FVC (mean difference [MD], 0.01; 95% CI − 0.03 to 0.05; p = 0.56) and DLCO (MD, 0.05; 95% CI − 0.17 to 0.28; p = 0.65). Additional use of antimicrobial agents was also associated with an increased risk of AEs (OR 1.65; 95% CI 1.19 to 2.27; p = 0.002), especially gastrointestinal disorders (OR 1.54; 95% CI 1.10 to 2.15; p = 0.001). In patients with IPF, adding antimicrobial therapy to usual care did not improve mortality or lung function decline but increased gastrointestinal toxicity.

中文翻译：

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额外抗菌治疗对特发性肺纤维化患者预后的影响：系统评价和荟萃分析

其他抗菌药物对特发性肺纤维化 (IPF) 患者临床结局的影响尚不清楚。我们对随机对照试验 (RCT) 进行了全面检索，这些试验比较了额外抗菌药物与安慰剂或常规治疗在 IPF 患者治疗中的临床疗效。主要结果是全因死亡率，次要结果是用力肺活量 (FVC)、肺一氧化碳弥散能力 (DLCO) 和不良事件风险 (AE) 的变化。这项荟萃分析包括四项随机对照试验，包括总共 1055 名患者（528 名接受额外抗生素，527 名接受安慰剂或常规治疗）。在研究组中，分别有 402 名和 126 名患者接受复方新诺明和强力霉素。全因死亡率为15。接受和未接受额外抗生素治疗的患者分别为 0% (79/528) 和 14.0% (74/527)（优势比 [OR] 1.07；95% 置信区间 [CI] 0.76 至 1.51；p = 0.71 ）。FVC（平均差 [MD]，0.01；95% CI - 0.03 至 0.05；p = 0.56）和 DLCO（MD，0.05；95% CI - 0.17 至 0.28；p = 0.65）的变化没有观察到显着差异. 额外使用抗菌药物也与 AE 风险增加相关（OR 1.65；95% CI 1.19 至 2.27；p = 0.002），尤其是胃肠道疾病（OR 1.54；95% CI 1.10 至 2.15；p = 0.001）。在 IPF 患者中，在常规护理的基础上添加抗菌药物治疗并不能改善死亡率或肺功能下降，但会增加胃肠道毒性。分别（优势比 [OR] 1.07；95% 置信区间 [CI] 0.76 至 1.51；p = 0.71）。FVC（平均差 [MD]，0.01；95% CI - 0.03 至 0.05；p = 0.56）和 DLCO（MD，0.05；95% CI - 0.17 至 0.28；p = 0.65）的变化没有观察到显着差异. 额外使用抗菌药物也与 AE 风险增加相关（OR 1.65；95% CI 1.19 至 2.27；p = 0.002），尤其是胃肠道疾病（OR 1.54；95% CI 1.10 至 2.15；p = 0.001）。在 IPF 患者中，在常规护理的基础上添加抗菌药物治疗并不能改善死亡率或肺功能下降，但会增加胃肠道毒性。分别（优势比 [OR] 1.07；95% 置信区间 [CI] 0.76 至 1.51；p = 0.71）。FVC（平均差 [MD]，0.01；95% CI - 0.03 至 0.05；p = 0.56）和 DLCO（MD，0.05；95% CI - 0.17 至 0.28；p = 0.65）的变化没有观察到显着差异. 额外使用抗菌药物也与 AE 风险增加相关（OR 1.65；95% CI 1.19 至 2.27；p = 0.002），尤其是胃肠道疾病（OR 1.54；95% CI 1.10 至 2.15；p = 0.001）。在 IPF 患者中，在常规护理的基础上添加抗菌药物治疗并不能改善死亡率或肺功能下降，但会增加胃肠道毒性。17 至 0.28；p = 0.65)。额外使用抗菌药物也与 AE 风险增加相关（OR 1.65；95% CI 1.19 至 2.27；p = 0.002），尤其是胃肠道疾病（OR 1.54；95% CI 1.10 至 2.15；p = 0.001）。在 IPF 患者中，在常规护理的基础上添加抗菌药物治疗并不能改善死亡率或肺功能下降，但会增加胃肠道毒性。17 至 0.28；p = 0.65)。额外使用抗菌药物也与 AE 风险增加相关（OR 1.65；95% CI 1.19 至 2.27；p = 0.002），尤其是胃肠道疾病（OR 1.54；95% CI 1.10 至 2.15；p = 0.001）。在 IPF 患者中，在常规护理的基础上添加抗菌药物治疗并不能改善死亡率或肺功能下降，但会增加胃肠道毒性。