Safety and Efficacy of Devices Delivering Inhaled Antibiotics among Adults with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and a Network Meta-Analysis
| Autor: | Sofia Tejada, Sergio Ramírez-Estrada, Carlos Forero, Miguel Gallego, Joan Soriano, Pablo Cardinal-Fernández, Stephan Ehrmann, Jordi Rello |
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| Přispěvatelé: | Institut Català de la Salut, [Tejada S] Grup de Recerca Clínica/Innovació en Pneumònia i Sèpsia (CRIPS), Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. [Ramírez-Estrada S] Intensive Care Department, Clínica Corachán, Barcelona, Spain. [Forero CG] School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain. [Gallego M] Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Respiratory Department, Parc Taulí University Hospital, Barcelona, Spain. [Soriano JB] Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain. [Cardinal-Fernández PA] Intensive Care Unit, HM Group, Madrid, Spain. [Ehrmann S] CHRU Tours, Médecine Intensive Réanimation, CIC INSERM 1415, CRICS-TriggerSEP F-CRIN Research Network, Tours, France. Centre d’étude des Pathologies Respiratoires, INSERM U1100, Université de Tours, Tours, France. [Rello J] Grup de Recerca Clínica/Innovació en Pneumònia i Sèpsia (CRIPS), Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Clinical Research in the ICU, CHU Nimes, Universite de Nimes-Montpellier, Nimes, France. Medicine Department, Universitat Internacional de Catalunya (UIC), Sant Cugat, Spain, Vall d'Hebron Barcelona Hospital Campus |
| Rok vydání: | 2022 |
| Předmět: |
Microbiology (medical)
Bronquièctasia Nebulizador de pequeño volumen Nebulitzador de petit volum Respiratory Tract Diseases::Bronchial Diseases::Bronchiectasis [DISEASES] 616.2 Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] Other subheadings::Other subheadings::/drug therapy [Other subheadings] Biochemistry Microbiology Antibióticos inhalados Fibrosis no quística Pols seca inhalada Inhaled antibiotics Pharmacology (medical) General Pharmacology Toxicology and Pharmaceutics Bronquiectasias Small-volume nebulizer Teràpia respiratòria Dry powder inhaled Polvo seco inhalado Bronchiectasis Infectious Diseases Non-cystic fibrosis Avaluació de resultats (Assistència sanitària) Fibrosi no quística Antibiòtics inhalats enfermedades respiratorias::enfermedades bronquiales::bronquiectasia [ENFERMEDADES] Bronquièctasi - Tractament |
| Zdroj: | Scientia |
| ISSN: | 2079-6382 |
| Popis: | Bronchiectasis; Dry powder inhaled; Inhaled antibiotics Bronquiectasias; Polvo seco inhalado; Antibióticos inhalados Bronquiectasies; Pols seca inhalada; Antibiòtics inhalats It remains unknown whether the type of aerosol generating device is affecting efficacy and safety among non-cystic fibrosis bronchiectasis (NCFB) adults. The proposal of this network meta-analysis (NMA) is to evaluate effectiveness and safety of inhaled antibiotics administered via dry powder inhaler (DPI) and via nebulizers (SVN) among adult patients with NCFB. Inclusion criteria were randomized-controlled trials, adults (≥18 years) with NCFB, and inhaled antibiotics administered via DPI as intervention. Search strategy was performed in PubMed, Web of Science, and Cochrane Library from 2000 to 2019. Sixteen trials (2870 patients) were included. Three trials (all ciprofloxacin) used DPIs and thirteen used SVN (three ciprofloxacin). Both DPI and SVN devices achieved similar safety outcomes (adverse events, antibiotic discontinuation, severe adverse events, and bronchospasm). Administration of ciprofloxacin via DPI significantly improved time to first exacerbation (87 days, 95% CI 34.3–139.7) and quality of life (MD −7.52; 95% CI −13.06 to −1.98) when compared with via SVN. No other significant differences were documented in clinical efficacy (at least one exacerbation, FEV1% predicted) and microbiologic response (bacterial eradication, emergence of new potential pathogens, and emergence of antimicrobial resistance) when comparing devices. Our NMA documented that time to first exacerbation and quality of life, were more favorable for DPIs. Decisions on the choice of devices should incorporate these findings plus other criteria, such as simplicity, costs or maintenance requirements. This work was funded by CIBERES, Instituto de Salud Carlos III, Madrid, Spain (Fondos FEDER) (CB06-06-036). |
| Databáze: | OpenAIRE |
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