Safety and efficacy of devices delivering Inhaled antibiotics among adults with non-cystic fibrosis bronchiectasis: a systematic review and a network meta-analysis
Author
Tejada, Sofia
Ramírez-Estrada, Sergio
G. Forero, Carlos
Gallego, Miguel
B. Soriano, Joan
Cardinal-Fernández, Pablo A.
Ehrmann, Stephan
Rello, Jordi
Publication date
2022ISSN
2079-6382
Abstract
It remains unknown whether the type of aerosol generating device is affecting efficacy and safety among non-cystic fibrosis bronchiectasis (NCFB) adults. The proposal of this network meta-analysis (NMA) is to evaluate effectiveness and safety of inhaled antibiotics administered via dry powder inhaler (DPI) and via nebulizers (SVN) among adult patients with NCFB. Inclusion criteria were randomized-controlled trials, adults (≥18 years) with NCFB, and inhaled antibiotics administered via DPI as intervention. Search strategy was performed in PubMed, Web of Science, and Cochrane Library from 2000 to 2019. Sixteen trials (2870 patients) were included. Three trials (all ciprofloxacin) used DPIs and thirteen used SVN (three ciprofloxacin). Both DPI and SVN devices achieved similar safety outcomes (adverse events, antibiotic discontinuation, severe adverse events, and bronchospasm). Administration of ciprofloxacin via DPI significantly improved time to first exacerbation (87 days, 95% CI 34.3–139.7) and quality of life (MD −7.52; 95% CI −13.06 to −1.98) when compared with via SVN. No other significant differences were documented in clinical efficacy (at least one exacerbation, FEV1% predicted) and microbiologic response (bacterial eradication, emergence of new potential pathogens, and emergence of antimicrobial resistance) when comparing devices. Our NMA documented that time to first exacerbation and quality of life, were more favorable for DPIs. Decisions on the choice of devices should incorporate these findings plus other criteria, such as simplicity, costs or maintenance requirements.
Document Type
Article
Document version
Published version
Language
English
Subject (CDU)
61 - Medical sciences
616.2 - Pathology of the respiratory system. Complaints of the respiratory organs
Keywords
Bronquièctasia
Fibrosi no quística
Pols seca inhalada
Nebulitzador de petit volum
Antibiòtics inhalats
Bronquiectasias
Fibrosis no quística
Polvo seco inhalado
Nebulizador de pequeño volumen
Antibióticos inhalados
Bronchiectasis
Non-cystic fibrosis
Dry powder inhaled
Small-volume nebulizer
Inhaled antibiotics
Pages
14
Publisher
MDPI
Collection
11;2
Is part of
Antibiotics
Citation
Tejada, Sofia; Ramírez-Estrada, Sergio; G. Forero, Carlos [et al.]. Safety and efficacy of devices delivering Inhaled antibiotics among adults with non-cystic fibrosis bronchiectasis: a systematic review and a network meta-analysis. Antibiotics, 2022, 11(2), 275. Disponible en: <https://www.mdpi.com/2079-6382/11/2/275>. Fecha de acceso: 21 mar. 2022. DOI: 10.3390/antibiotics11020275.
This item appears in the following Collection(s)
- Ciències de la Salut [712]
Rights
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by/4.0/