Long-term macrolides for non-cystic fibrosis bronchiectasis: A systematic review and meta-analysis

Long-term macrolides are increasingly being prescribed for stable bronchiectasis. This meta-analysis assessed the clinical effect of this treatment in bronchiectasis. A systematic review and meta-analysis were carried out. All randomized, controlled trials (RCT) comparing long-term macrolides with placebo and/or usual medical care, with outcome measures relating to efficacy and safety were selected. Nine RCT recruiting 530 patients were included. Compared with placebo and/or usual medical care, long-term macrolides significantly reduced the risk of the exacerbations (number of participants with exacerbations (relative risk=0.70, 95% confidence interval (CI) 0.60-0.82, P<0.00001); average exacerbations per participant (weighted mean difference=-1.01, 95% CI -1.35 to -0.67, P<0.00001)), the St George's Respiratory Questionnaire total scores (weighted mean difference=-5.39 95% CI -9.89 to -0.88, P=0.02), dyspnoea scale (weighted mean difference=-0.31 95% CI -0.42 to -0.20, P<0.00001), 24-h sputum volume (P<0.00001), and attenuated the decline of forced expiratory volume in 1s (weighted mean difference 0.02L, 95% CI 0.00-0.04, P=0.01). Eradication of pathogens (P=0.06), overall rate of adverse events (P=0.61), and emergence of new pathogens (P=0.61) were not elevated, while gastrointestinal events increased significantly with macrolides (P=0.0001). Macrolide resistance increased, but a meta-analysis was not possible due to the diversity of parameters. Long-term use of macrolides appears to be a treatment option for stable bronchiectasis. The results of this review justify further investigation about adding this intervention to the treatment regimens of bronchiectasis.