Efficacy and safety of macrolides in the treatment of children with bronchiectasis: a meta-analysis.

Abstract

BACKGROUND:

This study summarized the available randomized controlled trials (RCTs) to assess the efficacy and safety of macrolides on pathogens, lung function, laboratory parameters, and safety in children with bronchiectasis.

METHODS:

PubMed, EMBASE, and the Cochrane Library were searched for available papers published up to June 2021. The outcomes were the pathogens, adverse events (AEs), and the forced expiratory volume in one second (FEV1%) predicted.

RESULTS:

Seven RCTs (633 participants) were included. The long-term use of macrolides reduced the risk of the presence of Moraxella catarrhalis (RR = 0.67, 95% CI: 0.30-1.50, P = 0.001; I2 = 0.0%, Pheterogeneity = 0.433), but not Haemophilus influenza (RR = 0.19, 95% CI: 0.08-0.49, P = 0.333; I2 = 57.0%, Pheterogeneity = 0.040), Streptococcus pneumonia (RR = 0.91, 95% CI: 0.61-1.35, P = 0.635; I2 = 0.0%, Pheterogeneity = 0.515), Staphylococcus aureus (RR = 1.01, 95% CI: 0.36-2.84, P = 0.986; I2 = 61.9%, Pheterogeneity = 0.033), and any pathogens present (RR = 0.61, 95% CI: 0.29-1.29, P = 0.195; I2 = 80.3%, Pheterogeneity = 0.006). Long-term macrolides had no effect on FEV1% predicted (WMD = 2.61, 95% CI: -1.31, 6.53, P = 0.192; I2 = 0.0%, Pheterogeneity = 0.896). Long-term macrolides did not increase the risk of AEs or serious AEs.

CONCLUSION:

Macrolides do not significantly reduce the risk of pathogens present (except for Moraxella catarrhalis) or increase FEV1% predicted among children with bronchiectasis. Moreover, macrolides were not associated with AEs. Considering the limitations of the meta-analysis, further larger-scale RCTs are needed to confirm the findings.

IMPACT:

Macrolides do not significantly reduce the risk of pathogens present (except for Moraxella catarrhalis) among children with bronchiectasis. Macrolides do not significantly increase FEV1% predicted among children with bronchiectasis. This meta-analysis reports on the efficacy and safety of macrolides in the treatment of children with bronchiectasis, providing evidence for the management of children with bronchiectasis. This meta-analysis does not support the use of macrolides in the management of children with bronchiectasis unless the presence of Moraxella catarrhalis is provenor suspected.

• Authors: Guihua Song, Yan Zhang, Suping Yu, Mengmeng Sun, Bingxue Zhang, Minghao Peng, Weigang Lv, Hongyun Zhou
• Journal: Pediatric research (Pediatr Res) Vol. 94 Issue 5 Pg. 1600-1608 (11 2023) ISSN: 1530-0447 [Electronic] United States
• PMID: 37237074 (Publication Type: Meta-Analysis, Systematic Review)
• Copyright: © 2023. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

Chemical References

• Macrolides
• Anti-Bacterial Agents

Topics

• Humans
• Child
• Macrolides (adverse effects)
• Anti-Bacterial Agents (adverse effects)
• Bronchiectasis (diagnosis, drug therapy, chemically induced)
• Respiratory Function Tests
• Forced Expiratory Volume
• Randomized Controlled Trials as Topic