Safety and Efficacy of Devices Delivering Inhaled Antibiotics among Adults with Non-Cystic Fibrosis Bronchiectasis : A Systematic Review and a Network Meta-Analysis
Tejada, Sofia (Hospital Universitari Vall d'Hebron)
Ramírez-Estrada, Sergio (Clínica Corachán. Intensive Care Department)
Forero, Carlos G. (Universitat Internacional de Catalunya)
Gallego, Miguel (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Soriano, Joan B. (Universidad Autónoma de Madrid)
Cardinal-Fernández, Pablo A. (HM Group (Madrid))
Ehrmann, Stephan (Université de Tours. Centre d'étude des Pathologies Respiratoires)
Rello, Jordi (Vall d'Hebron Institut de Recerca (VHIR))

Fecha:	2022
Resumen:	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, FEV% 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.
Ayudas:	Instituto de Salud Carlos III CB06-06-036
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article de revisió ; recerca ; Versió publicada
Materia:	Bronchiectasis ; Non-cystic fibrosis ; Dry powder inhaled ; Small-volume nebulizer ; Inhaled antibiotics
Publicado en:	Antibiotics, Vol. 11 Núm. 2 (february 2022) , ISSN 2079-6382

DOI: 10.3390/antibiotics11020275
PMID: 35203878

14 p, 2.0 MB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Instituto de Investigación e Innovación Parc Taulí (I3PT)
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