Guideline rethink for wider use of macrolides in bronchiectasis patients


By Emma Wilkinson

27 Aug 2019

Treatment guidelines for bronchiectasis may need review, say researchers after two studies on antibiotic use raised questions over current practice.

In one meta-analysis, long-term macrolide antibiotic therapy was found to reduce the frequency of exacerbations across the board, even in patients with only one or two exacerbations a year.

The results, published in The Lancet, suggest that macrolides would benefit a wider group of bronchiectasis patients than those with three or more exacerbations a year as recommended in the guidelines.

Of particular interest, says study author Professor James Chalmers, British Lung Foundation Professor of Respiratory Research at the University of Dundee, was the finding that macrolides were of similar benefit in those with P. aeruginosa.

A second meta analysis, by Professor Chalmers and colleagues, also in The Lancet, found that while the use of inhaled antibiotics was well tolerated, reduced bacterial load, and achieved a small but significant reduction in exacerbation frequency in patients with bronchiectasis, there were no clinically significant improvements in quality of life.

 Professor Chalmers said that taken together, the results provide important clarification for clinicians.

“Doctors are using lots of both macrolides and inhaled antibiotics in these patients at the moment but the question is do they work, who do they work in and when should we use them?

“We found that macrolides are substantially more effective than inhaled antibiotics. They reduced exacerbations by 50%, the equivalent for inhaled antibiotics was 20%.

“This wasn’t a head-to-head trial but our data suggests that macrolides are probably the most effective approach.”

He added that the results did not mean clinicians should opt straight for macrolides without doing a full workup of the patient, as there were some for whom the drugs would do more harm than good.

“But it does turn a lot of what we’ve been doing with these drugs on its head.”

Professor Chalmers also pointed out that the key part of their data on inhaled antibiotics was that they did not improve quality of life or symptoms.

“This is not about using more antibiotics, it’s about using them smarter in patients where it is going to be of benefit.” 

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