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7377200ffe820cbb1e466561b8903109061ddd7f9fe9a648c36a27ae559e81d7  pmc_35203878.pdf

Title:          Safety and Efficacy of Devices Delivering Inhaled Antibiotics among Adults with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and a Network Meta-Analysis
Subject:        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.
Keywords:       bronchiectasis; non-cystic fibrosis; dry powder inhaled; small-volume nebulizer; inhaled antibiotics
Author:         Sofia Tejada, Sergio Ramírez-Estrada, Carlos G. Forero, Miguel Gallego, Joan B. Soriano, Pablo A. Cardinal-Fernández, Stephan Ehrmann and Jordi Rello
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    Title: Safety and Efficacy of Devices Delivering Inhaled Antibiotics among Adults with Non-Cystic Fibrosis Bronchiectasis: A Systematic Review and a Network Meta-Analysis
    Author: Sofia Tejada, Sergio Ramírez-Estrada, Carlos G. Forero, Miguel Gallego, Joan B. Soriano, Pablo A. Cardinal-Fernández, Stephan Ehrmann and Jordi Rello
    Subject: 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.
    Keywords: bronchiectasis; non-cystic fibrosis; dry powder inhaled; small-volume nebulizer; inhaled antibiotics
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       Subtype: Link
       Rect: 192, 539, 230, 550
      Annotation: 
       Subtype: Link
       Rect: 236, 539, 272, 550
      Annotation: 
       Subtype: Link
       Rect: 423, 505, 461, 516
      Annotation: 
       Subtype: Link
       Rect: 478, 470, 515, 481
      Annotation: 
       Subtype: Link
       Rect: 521, 470, 557, 481
      Annotation: 
       Subtype: Link
       Rect: 240, 436, 278, 447
      Annotation: 
       Subtype: Link
       Rect: 403, 401, 441, 412
      Annotation: 
       Subtype: Link
       Rect: 447, 401, 483, 412
      Annotation: 
       Subtype: Link
       Rect: 339, 378, 376, 389
      Annotation: 
       Subtype: Link
       Rect: 383, 378, 419, 389
      Annotation: 
       Subtype: Link
       Rect: 469, 355, 506, 366
      Annotation: 
       Subtype: Link
       Rect: 373, 321, 410, 332
      Annotation: 
       Subtype: Link
       Rect: 438, 286, 475, 297
      Annotation: 
       Subtype: Link
       Rect: 59, 241, 96, 251
      Annotation: 
       Subtype: Link
       Rect: 327, 217, 365, 228
      Annotation: 
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       Rect: 371, 217, 407, 228
      Annotation: 
       Subtype: Link
       Rect: 322, 194, 360, 205
      Annotation: 
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       Rect: 366, 194, 402, 205
  Checksum: 2b0ae092
   Type: CRC32
  Checksum: 9e78bc1d5442afc8c196b483135f078e
   Type: MD5
  Checksum: 244b9ef59ef6ebacf897dc935b5d4e178911c8ef
   Type: SHA-1