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Which patients with bronchiectasis benefit from long-term antibiotics?
Current bronchiectasis guidelines recommend that long-term macrolide antibiotics should be given to patients with frequent exacerbations and those without Pseudomonas aeruginosa infection. This study attempts to address the calls from the European Respiratory Society and the Cochrane Collaboration for further work in identifying the subgroups of patients with bronchiectasis who will benefit most from macrolide treatment (Chalmers et al, Lancet Respir Med 2019;7;845). This systematic review and meta-analysis addresses this using individual patient data from three randomised controlled trials providing data on 173 subjects on macrolide therapy and 168 on placebo. Consistent with the individual trials, the analysis found that macrolide therapy was associated with a significant reduction in the frequency of exacerbations over 6–12 months (adjusted incidence rate ratio 0.49, 95% CI 0.36 to 0.66; p<0.0001). The authors examined prespecified subgroups and found no significant interaction effects of these subgroups except for the cause of bronchiectasis (pinteraction=0.034). Notably, there was similar efficacy of therapy in patients with and without P. aeruginosa in baseline sputum culture (incident rate ratio (IRR) 0.36, 95% CI 0.18 to 0.72, p=0.004, and IRR …
Competing interests None declared.
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Provenance and peer review Commissioned; internally peer reviewed.
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