4.3 Review

Azithromycin or erythromycin? Macrolides for non-cystic fibrosis bronchiectasis in adults: A systematic review and adjusted indirect treatment comparison

Journal

CHRONIC RESPIRATORY DISEASE
Volume 16, Issue -, Pages -

Publisher

SAGE PUBLICATIONS LTD
DOI: 10.1177/1479972318790269

Keywords

Bronchiectasis; macrolides; adjusted indirect treatment comparison; meta-analysis; erythromycin; azithromycin

Funding

  1. National Natural Science Foundation of China [81373517, 81460694, 81760841]
  2. Project of Education Department of Guizhou Province [K[2017]041, KY[2017]172]
  3. Project of Administration of traditional Chinese medicine of Guizhou province [S201707260030]
  4. Natural Science Foundation of Science and Technology Department of Guizhou Province [J[2012]2086]

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Non-cystic fibrosis (non-CF) bronchiectasis is a condition characterized by an airway inflammatory response to bacterial pathogens. Frequent exacerbations have a major influence on the quality of life. Macrolide antibiotics have not only antibacterial but also immune-regulation effects. It is proved that macrolides have a benefit in preventing exacerbations. However, it is still uncertain whether azithromycin or erythromycin is more effective and safe. The purpose of this study was to answer the following question: Which kind of macrolide antibiotic is more effective and safe in preventing non-CF bronchiectasis exacerbation? We conducted a systematic review to identify randomized clinical trials published up to May 2017 that reported on macrolides for non-CF bronchiectasis and an adjusted indirect treatment comparison (AITC) between macrolides to evaluate their efficacy and safety. The direct comparison meta-analysis found that macrolides decreased the rate of exacerbation of non-CF bronchiectasis (risk ratio (RR) = 0.45; 95% confidence interval (CI) 0.36-0.55) with heterogeneity (I-2 = 63.7%, p = 0.064). The AITC showed that azithromycin had a significantly lower bronchiectasis exacerbation rate than erythromycin (RR = 0.35; 95% CI: 0.403-0.947). Azithromycin increased the risk of diarrhea and abnormal pain. This meta-analysis suggested that long-term treatment with macrolides significantly reduced the incidence of non-CF bronchiectasis exacerbation. Moreover, azithromycin is more efficient than roxithromycin and erythromycin in preventing exacerbation.

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