Intern Med J. 2021 Jan 19. doi: 10.1111/imj.15210. Online ahead of print.
BACKGROUND: No antibiotic therapies have been approved for reducing exacerbations and preventing disease progression in non-cystic fibrosis bronchiectasis (NCFB) patients. Several recent clinical studies have investigated the feasibility of inhaled ciprofloxacin in NCFB, whereas the results were controversial.
METHOD: Electrical databases Medline and Cochrane library were retrieved from inception through December, 2019. Randomized controlled trials (RCTs) comparing inhaled ciprofloxacin and placebo were selected. The primary outcomes were time to first exacerbation, frequency of exacerbations and the change in sputum Pseudomonas aeruginosa density.
RESULTS: A total of five articles involving 6 RCTs were finally included in the analysis. The time to first exacerbation was significantly prolonged by inhaled ciprofloxacin (Hazard ratio: 0.72, 95% confidence interval (CI): 0.63-0.82), with low heterogeneity (I2 = 23%). Inhalation of ciprofloxacin significantly reduced frequency of exacerbations (Risk ratio: 0.70, 95% CI: 0.61-0.79) and decreased density of sputum Pseudomonas aeruginosa (Weighted mean difference: -2.11 log10 CFU/g, 95% CI: -2.96 to -1.27 log10 CFU/g) compared with placebo. No significant between-group differences in mortality, adverse events and discontinuation rate were observed. Further indirect treatment comparison showed no differences between the two types of inhaled ciprofloxacin in all outcomes of interest.
CONCLUSION: Ciprofloxacin inhalation treatment significantly prolonged the time to first exacerbation, reduced the frequency of exacerbations and decreased sputum Pseudomonas aeruginosa density, and was well-tolerated. Ciprofloxacin inhalation is promising in treatment of NCFB. This article is protected by copyright. All rights reserved.