Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil.
Cochrane Airway Group, Population Health Sciences and Education, St George's University of London, London, UK.
Eur Respir J. 2014 Aug;44(2):382-93. doi: 10.1183/09031936.00018414. Epub 2014 Jun 12.
We conducted a meta-analysis of randomised trials to evaluate the efficacy and safety of inhaled antibiotics in patients with stable non-cystic fibrosis (CF) bronchiectasis. We searched the Cochrane Airways Group Register of Trials from inception until March 2014. 12 trials with 1264 adult patients were included, of which five were unpublished studies. Eight trials on 590 patients contributed data to the meta-analysis. Amikacin, aztreonam, ciprofloxacin, gentamicin, colistin or tobramycin were used for 4 weeks to 12 months. Inhaled antibiotics were more effective than placebo or symptomatic treatment in reducing sputum bacterial load (five trials; weighted mean difference -2.65 log10 CFU · g(-1), 95% CI -4.38- -0.92 log10 CFU · g(-1)), eradicating the bacteria from sputum (six trials; risk ratio 4.2, 95% CI 1.66-10.64) and reducing the risk of acute exacerbations (five trials; risk ratio 0.72, 95% CI 0.55-0.94). Bronchospasm occurred in 10% of patients treated with inhaled antibiotics compared with 2.3% in the control group (seven trials; risk ratio 2.96, 95% CI 1.30-6.73), but the two groups had the same withdrawal rate due to adverse events (12.2%). Inhaled antibiotics may provide an effective suppressive antibiotic therapy with an acceptable safety profile in adult patients with stable non-CF bronchiectasis and chronic bronchial infection.
我们进行了一项荟萃分析，以评估吸入抗生素在稳定型非囊性纤维化（CF）支气管扩张症患者中的疗效和安全性。我们从成立开始到 2014 年 3 月搜索了 Cochrane Airways 组试验登记册。共有 12 项试验纳入了 1264 名成年患者，其中 5 项为未发表的研究。8 项针对 590 名患者的试验提供了数据用于荟萃分析。使用阿米卡星、氨曲南、环丙沙星、庆大霉素、黏菌素或妥布霉素治疗 4 周至 12 个月。与安慰剂或对症治疗相比，吸入抗生素更有效地降低痰细菌负荷（5 项试验；加权均数差-2.65 log10 CFU·g(-1)，95%CI -4.38- -0.92 log10 CFU·g(-1)）、从痰中清除细菌（6 项试验；风险比 4.2，95%CI 1.66-10.64）和降低急性加重风险（5 项试验；风险比 0.72，95%CI 0.55-0.94）。与对照组（7 项试验；风险比 2.96，95%CI 1.30-6.73）相比，接受吸入抗生素治疗的患者中有 10%发生支气管痉挛，而对照组为 2.3%，但两组因不良事件而退出的比例相同（12.2%）。在稳定型非 CF 支气管扩张症和慢性支气管感染的成年患者中，吸入抗生素可能提供一种有效的抑制抗生素治疗，并具有可接受的安全性。
