Macrolide antibiotics for bronchiectasis

What is it about?

Background to the question Bronchiectasis is a long-term respiratory condition. The airways in the lungs are damaged, and people are prone to infection. Symptoms are chronic cough and the production of sputum (coughed-up material (phlegm) from the lower airways). Moreover, bronchiectasis is associated with a mortality rate more than twice that of the general population. Long-term antibiotic therapy with macrolides (such as azithromycin, roxithromycin, erythromycin, and clarithromycin) may reduce the cycle of reinfection, reduce symptoms, and improve quality of life. We wanted to do this review to look at the evidence on use of macrolides in people with bronchiectasis. This review is intended to help people such as guideline producers, doctors, and patients make decisions about whether to use or recommend macrolides. Study characteristics We found 15 studies that compared macrolides with placebo (a substance or treatment with no benefit) or no intervention. Eleven studies involved 690 adults (aged 18 years and older) and four studies involved 190 children. Among adults, six used azithromycin, four roxithromycin, and one erythromycin. The four studies with children used azithromycin, clarithromycin, erythromycin, or roxithromycin. This review is current to January 2018. Main results The studies on azithromycin reported improved quality of life in adults. We do not have sufficient evidence from other macrolides to make a robust judgement on their use, and we similarly have insufficient evidence from children to draw clear conclusions. Although we found only a few trials, they do show a possible increase in antibiotic resistance. Antibiotic resistance is seen when an antibiotic becomes less effective at killing the bacteria causing the chest infection. We know that macrolides are associated with higher risk of cardiovascular death and other serious adverse events when they are used to treat other conditions. The data in our review suggest it is possible that people with bronchiectasis are at risk for these adverse effects when taking macrolides.

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Why is it important?

It is important that the evidence underpinning all interventions including antibiotic therapy have a strong evidence base.