Long-Term Macrolide Treatment for Non-Cystic Fibrosis Bronchiectasis in Children: A Meta-Analysis
Abstract Recurrent bacterial infection causes frequent exacerbations of Bronchiectasis (BE). The effectiveness and safety of macrolide long-term administration in BE remains controversial, especially in children with little treatment to prevent exacerbation. We conducted this meta-analysis to determine the usefulness of long-term macrolide in pediatric BE. We searched PubMed, Cochrane Library databases, Embase, KoreaMed, Igaku Chuo Zasshi, and Chinese National Knowledge Infrastructure databases. We identified randomized controlled trials (RCTs) on long-term macrolide treatment (≥ 4 weeks) in non-cystic fibrosis BE in children aged < 18 years. The primary outcome was frequency of acute exacerbation; secondary outcomes were changes in pulmonary function, sputum scores, and adverse events including bacterial resistance. We included four RCTs. Long-term macrolide treatment showed a significant decrease in the frequency of exacerbation (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.10 to 0.87), mean number of exacerbations per patient (mean difference, -1.40; 95% CI, -2.26 to -0.54) and sputum purulence score (mean difference, -0.78; 95% CI, -1.32 to -0.24). However, long-term macrolide treatment was accompanied by increased carriage of azithromycin-resistant bacteria (OR, 7.13). Long-term macrolide administration prevents exacerbation of BE in children, but risks increasing antibiotic resistance. Benefits and risks should be weighed and determined on a patient-by-patient basis.