Journal articles: 'Antibiotics and bronchiectasis'

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Suarez-Cuartin, Guillermo, Marta Hernandez-Argudo, Lidia Perea, and Oriol Sibila. "Long-Term Antibiotics in Bronchiectasis." Seminars in Respiratory and Critical Care Medicine 42, no. 04 (July 14, 2021): 606–15. http://dx.doi.org/10.1055/s-0041-1730945.

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AbstractA significant proportion of bronchiectasis patients are chronically infected by potentially pathogenic microorganisms which may lead to frequent exacerbations and worse clinical outcomes. Current bronchiectasis guidelines recommend long-term inhaled antibiotics and/or oral macrolides as a part of patient management. In recent years, an increasing amount of evidence assessing the impact of these treatments on patient outcomes has been collected. Inhaled antibiotics have demonstrated significant improvements in sputum bacterial load, but their impact on patient quality of life, lung function, and exacerbation rate has not been consistent across trials. In this regard, recent post hoc analyses of inhaled antibiotics trials in bronchiectasis patients have shown that sputum bacterial load may be a key biomarker to predict treatment response in these patients. Oral macrolides, on the other hand, have proven to reduce exacerbation frequency and improve quality of life, but potential drug-related adverse effects and the increase in bacterial resistance are relevant. This review aims to summarize current important evidence for long-term antibiotic treatment in bronchiectasis patients.

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Polverino, Eva, Edmundo Rosales-Mayor, and VictoriaAlcaraz Serrano. "Inhaled antibiotics in bronchiectasis." Community Acquired Infection 2, no. 1 (2015): 8. http://dx.doi.org/10.4103/2225-6482.153856.

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T. King, Paul, and Peter W. Holmes. "Use of Antibiotics in Bronchiectasis." Reviews on Recent Clinical Trials 7, no. 1 (February 1, 2012): 24–30. http://dx.doi.org/10.2174/157488712799363280.

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Nadig, Tejaswi R., and Patrick A. Flume. "Aerosolized Antibiotics for Patients with Bronchiectasis." American Journal of Respiratory and Critical Care Medicine 193, no. 7 (April 2016): 808–10. http://dx.doi.org/10.1164/rccm.201507-1449le.

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OBILIŞTEANU, Gabriela C., Alexandru MATEI, Loredana MANOLESCU, Viviana DRAGODAN, Ruxandra ULMEANU, and Florin D. MIHĂLŢAN. "Updated therapies in bronchiectasis." Romanian Journal of Medical Practice 12, no. 2 (June 30, 2017): 91–96. http://dx.doi.org/10.37897/rjmp.2017.2.6.

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Objective. The aim of this study is to evaluate the constantly updated and integrated treatment strategies for the improvement and the cure of bronchiectasis, with a beneficial effect on the quality of life of patients diagnosed with this disease. Material and method. The retrospective study (december 17th 2014 – june 2nd 2015), was conducted on 89 patients hospitalised in the Pneumophtysiology Institute "Marius Nasta" in Bucharest, with the confirmed clinical diagnosis of non cystic fibrosis bronchiectasis. From the clinical observation charts of the patients included in the study, we evaluated the treatment strategies applied for each patient in correlation with the confirmed clinical diagnosis. The therapies applied included antimicrobial, mucolytic, bronchodilator, corticosteroid, immunotherapy treatment, pulmonary rehabilitation, treatment of associated disease (ORL and gastro-oesophageal reflux), hygiene diet and antidepressant treatment. Results. The microbial etiology identified in the sputum (17,97%) consisted of Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus parainfluenzae, Streptococcus pyogenes and Candida albicans, 82,03% of the cases presented non-specific (normal) flora. The associated therapy of antibiotic treatment (cephalosporin + fluoroquinolone) + mucolytic agent (erdosteine) + corticosteroid & β adrenergic agonist + anticolinergic agent + nonsteroid anti-inflammatory + anti-influenza vaccination + immunotherapy was the most efficient and the most used first-intention therapeutic association (35/39,32%). All the patients were discharged with improved bronchiectatic status. Discussions. The present study, with multiple date regarding the treatment of the acute disease, revealed the importance and the benefit of the multitype therapy, continuously updated, for the treatment of bronchiectasis of various degrees of severity. In time, the treatment can have serious side effects for the patient and the community in regard to antibiotic resistance; the severity and the complications' risk offers an useful background for taking clinical decisions that patients require long term treatment courses, such as macrolides, airway adjuvants, inhalatory antibiotics and other measures. Conclusions. Future studies should refer to a greater number of patients with varying degrees of severity of this disease, with more specific etiological information and with a longer duration, to clarify the actual benefits of new promising therapies and to offer new perspectives on the medical approach of bronchiectasis.

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Gross-Hodge, Ellen, Will D. Carroll, Naomi Rainford, Carrol Gamble, and Francis J. Gilchrist. "Duration of initial antibiotic course is associated with recurrent relapse in protracted bacterial bronchitis." Archives of Disease in Childhood 105, no. 11 (October 17, 2019): 1111–13. http://dx.doi.org/10.1136/archdischild-2019-317917.

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Protracted bacterial bronchitis (PBB) is the leading cause of chronic wet cough in young children from developed countries. Despite its high prevalence there is a paucity of evidence to inform the optimal duration of treatment leading to variation in practice. Relapse of chronic cough is common and recurrent PBB (>3 episodes in 12 months) is associated with a future diagnosis of bronchiectasis. We investigated the factors associated with any relapse (≥1 episode in 12 months) and recurrent PBB in 66 children. No factor was significantly associated with any relapse. Duration of initial antibiotic treatment was the only factor significantly associated with recurrent PBB. Those who received antibiotics for 6 weeks antibiotics were less likely to develop recurrent PBB than those who received for 2 weeks (p=0.046). This is the first study to show an association between duration of initial antibiotic course and therefore future bronchiectasis. Prospective studies are needed to investigate this association.

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Webb, Philip, Jenny King, Caroline Baxter, and Robert W. Lord. "Management of non-cystic fibrosis bronchiectasis." British Journal of Hospital Medicine 82, no. 7 (July 2, 2021): 1–9. http://dx.doi.org/10.12968/hmed.2020.0739.

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Bronchiectasis is a common respiratory condition, characterised by abnormal bronchial dilatation, that often leads to recurrent airway infection and inflammation. It is an increasingly recognised respiratory condition, both as a primary lung disease but also co-existing with other respiratory diseases, such as chronic obstructive pulmonary disease and asthma. Diagnosis can have important treatment implications. There are shared systematic approaches to treatment, such as sputum clearance techniques, prompt treatment of exacerbations and, in certain circumstances, regular antibiotic therapy. It is vital to target antibiotic therapy appropriately, and knowledge of the patient's airway microbiology can assist with this. Certain infective and colonising organisms, such as Pseudomonas aeruginosa, cause worse patient outcomes and so need prompt treatment with appropriate antibiotics. In addition to this general management approach, there are many different underlying causes of bronchiectasis that should be identified wherever possible, to support more targeted therapy and prevent disease progression. This article provides a guide to the key principles of diagnosing and managing bronchiectasis, and outlines situations where more specialist respiratory support is required.

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Choi, Hayoung, Hyun Lee, Seung Won Ra, and Yeon-Mok Oh. "Update on pharmacotherapy for adult bronchiectasis." Journal of the Korean Medical Association 63, no. 8 (August 10, 2020): 486–92. http://dx.doi.org/10.5124/jkma.2020.63.8.486.

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Bronchiectasis refers to abnormal dilatation of the bronchi, which leads to the failure of mucus clearance and increased risk of infection. Pharmacotherapy for stable bronchiectasis includes oral or inhaled mucoactive agents, anti-inflammatory therapy, inhaled bronchodilators, long-term antibiotics, and long-term macrolide treatment. Among them, mucoactive agents are the most common adjunctive agents to airway clearance techniques. When patients with impaired lung function suffer from dyspnea, inhaled bronchodilators may be prescribed to relieve the symptom. Long-term macrolide treatment has been proven to prevent exacerbation in patients with frequent bronchiectasis exacerbation. If exacerbation occurs despite the above mentioned treatments, one or two weeks of antibiotics should be prescribed to cover respiratory bacteria that include <i>Pseudomonas aeruginosa</i>. Because evidence supporting the use of pharmacotherapy for bronchiectasis is weak, further research is warranted.

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Rubin, Bruce K. "Aerosolized Antibiotics for Non-Cystic Fibrosis Bronchiectasis." Journal of Aerosol Medicine and Pulmonary Drug Delivery 21, no. 1 (March 2008): 71–76. http://dx.doi.org/10.1089/jamp.2007.0652.

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Rubin, Bruce K., and Ronald W. Williams. "Aerosolized Antibiotics for Non-Cystic Fibrosis Bronchiectasis." Respiration 88, no. 3 (2014): 177–84. http://dx.doi.org/10.1159/000366000.

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Abu Dabrh, Abd Moain, Adam T. Hill, Claudia C. Dobler, Noor Asi, Wigdan H. Farah, Qusay Haydour, Zhen Wang, Khalid Benkhadra, Larry J. Prokop, and Mohammad Hassan Murad. "Prevention of exacerbations in patients with stable non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis of pharmacological and non-pharmacological therapies." BMJ Evidence-Based Medicine 23, no. 3 (April 20, 2018): 96–103. http://dx.doi.org/10.1136/bmjebm-2018-110893.

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BackgroundSeveral pharmacological and non-pharmacological therapies are used to treat stable bronchiectasis of non-cystic fibrosis (CF) aetiology.ObjectiveWe conducted a systematic review and meta-analysis to assess the evidence of the effectiveness of pharmacological and non-pharmacological treatment options in patients with stable non-CF bronchiectasis with a focus on reducing exacerbations.Study selectionMultiple databases were searched through September 2017. Outcomes included the number of patients with exacerbation events, mean number of exacerbations, hospitalisations, mortality, quality of life measures, and safety and adverse effects. Meta-analysis was conducted using the random effects model.Findings30 randomised controlled trials enrolled subjects with non-CF bronchiectasis using different interventions. Moderate-quality evidence supported the effect of long-term antibiotics (≥3 months) on lowering the number of patients experiencing exacerbation events (relative risk 0.77 (95% CI 0.68 to 0.89)), reducing number of exacerbations (incidence rate ratio 0.62 (95% CI 0.49 to 0.78)), improving forced expiratory volume (litre) in the first second (FEV1) (weighted mean difference (WMD); 0.02 (95% CI 0.00 to 0.04)), decreasing sputum purulence scores (numerical scale of 1-8) (WMD −0.90 (95% CI −1.58 to −0.22)) and improving quality of life scores assessed by the St George’s Respiratory Questionnaire (WMD −6.07 (95% CI −10.7 to −1.43)). Bronchospasm increased with inhaled antibiotics while diarrhoea increased particularly with oral macrolide therapy.ConclusionsModerate-quality evidence supports long-term antibiotic therapy for preventing exacerbations in stable non-CF bronchiectasis. However, data about the optimum agent, mode of therapy and length of treatment are limited. There is paucity of high-quality evidence to support the management of stable non-CF bronchiectasis including prevention of exacerbations.

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Scioscia, Giulia, Rosanel Amaro, Victoria Alcaraz-Serrano, Albert Gabarrús, Patricia Oscanoa, Laia Fernandez, Rosario Menendez, Raul Mendez, Maria Pia Foschino Barbaro, and Antoni Torres. "Clinical Factors Associated with a Shorter or Longer Course of Antibiotic Treatment in Patients with Exacerbations of Bronchiectasis: A Prospective Cohort Study." Journal of Clinical Medicine 8, no. 11 (November 12, 2019): 1950. http://dx.doi.org/10.3390/jcm8111950.

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Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

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Li, Wen, Zhong Qin, Jie Gao, Zhibin Jiang, Yihui Chai, Liancheng Guan, and Yunzhi Chen. "Azithromycin or erythromycin? Macrolides for non-cystic fibrosis bronchiectasis in adults: A systematic review and adjusted indirect treatment comparison." Chronic Respiratory Disease 16 (August 12, 2018): 147997231879026. http://dx.doi.org/10.1177/1479972318790269.

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Non-cystic fibrosis (non-CF) bronchiectasis is a condition characterized by an airway inflammatory response to bacterial pathogens. Frequent exacerbations have a major influence on the quality of life. Macrolide antibiotics have not only antibacterial but also immune-regulation effects. It is proved that macrolides have a benefit in preventing exacerbations. However, it is still uncertain whether azithromycin or erythromycin is more effective and safe. The purpose of this study was to answer the following question: Which kind of macrolide antibiotic is more effective and safe in preventing non-CF bronchiectasis exacerbation? We conducted a systematic review to identify randomized clinical trials published up to May 2017 that reported on macrolides for non-CF bronchiectasis and an adjusted indirect treatment comparison (AITC) between macrolides to evaluate their efficacy and safety. The direct comparison meta-analysis found that macrolides decreased the rate of exacerbation of non-CF bronchiectasis (risk ratio (RR) = 0.45; 95% confidence interval (CI) 0.36–0.55) with heterogeneity ( I2 = 63.7%, p = 0.064). The AITC showed that azithromycin had a significantly lower bronchiectasis exacerbation rate than erythromycin (RR = 0.35; 95% CI: 0.403–0.947). Azithromycin increased the risk of diarrhea and abnormal pain. This meta-analysis suggested that long-term treatment with macrolides significantly reduced the incidence of non-CF bronchiectasis exacerbation. Moreover, azithromycin is more efficient than roxithromycin and erythromycin in preventing exacerbation.

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Marra, R., G. Sgalla, L. Richeldi, E. G. Conte, and A. T. Hill. "Role of Stenotrophomonas maltophilia isolation in patients with non-CF bronchiectasis." QJM: An International Journal of Medicine 113, no. 10 (April 10, 2020): 726–30. http://dx.doi.org/10.1093/qjmed/hcaa120.

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Abstract Introduction Stenotrophomonas maltophilia is a bacteria whose role in patients with cystic fibrosis (CF) bronchiectasis has been previously studied; little is known about its role in non-CF bronchiectasis. Materials and methods Aim of our study is to investigate the risk factors for S. maltophilia acquisition and its clinical impact on bronchiectasis patients. A retrospective observational cohort study enrolling patients attending the Bronchiectasis Clinic at the Royal Infirmary of Edinburgh, Scotland, UK. A total of 167 bronchiectasis patients undergoing intravenous (IV) antibiotic therapy were selected and divided according to single or chronic S. maltophilia isolation in sputum. The risk factors and prognostic impact were studied. Results Single isolation was independently associated with lower baseline % predicted forced expiratory volume in 1 s [odds ratio (OR) 0.98; 95% confidence interval (CI) 0.970–1.044; P = 0.025] and with less radiological involvement (OR 0.379; 95% CI 0.175–0.819; P = 0.01). Chronic isolation was associated with the number of IV antibiotic courses in the year before and after the first isolation (OR 1.2; 95% CI 1.053–1.398; P = 0.007) and with the absence of Pseudomonas aeruginosa colonization (OR 0.207; 95% CI 0.056–0.764; P = 0.02). In the chronic isolation group, there were more exacerbations and more need of IV antibiotics in the year after the first isolation. Conclusions Poor lung function is the main independent risk factor for single isolation of S. maltophilia. For chronic colonization, the main independent risk factor is the number of IV antibiotic courses and the absence of P. aeruginosa chronic colonization. Only when chronically present, S. maltophilia had a clinical impact with more exacerbations.

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Grillo, Lizzie, Samantha Irving, David M. Hansell, Arjun Nair, Bertrand Annan, Simon Ward, Diana Bilton, et al. "The reproducibility and responsiveness of the lung clearance index in bronchiectasis." European Respiratory Journal 46, no. 6 (September 4, 2015): 1645–53. http://dx.doi.org/10.1183/13993003.00152-2015.

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Lung clearance index (LCI) is a potential clinical outcome marker in bronchiectasis. Its responsiveness to therapeutic intervention has not been determined. This study evaluates its responsiveness to a session of physiotherapy and intravenous antibiotic treatment of an exacerbation.32 stable and 32 exacerbating bronchiectasis patients and 26 healthy controls were recruited. Patients had LCI and lung function performed before and after physiotherapy on two separate occasions in the stable patients and at the beginning and end of an intravenous antibiotic course in the exacerbating patients.LCI was reproducible between visits in 25 stable patients, with an intraclass correlation of 0.978 (0.948, 0.991; p<0.001). There was no significant difference in LCI (mean±sd) between stable 11.91±3.39 and exacerbating patients 12.76±3.47, but LCI was significantly higher in both bronchiectasis groups compared with healthy controls (7.36±0.99) (p<0.001). Forced expiratory volume in 1 s improved after physiotherapy, as did alveolar volume after intravenous antibiotics, but LCI did not change significantly.LCI is reproducible in stable bronchiectasis but unlike conventional lung function tests, is unresponsive to two short-term interventions and hence is unlikely to be a useful clinical tool for short-term acute assessment in these patients. Further evaluation is required to establish its role in milder disease and in the evaluation of long-term interventions.

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Berry, Matthew Paul Reddoch. "The Use of Long-term Antibiotics in Bronchiectasis." Clinical Pulmonary Medicine 19, no. 2 (March 2012): 62–70. http://dx.doi.org/10.1097/cpm.0b013e3182493b05.

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Johnson, Chris, and Charles S. Haworth. "Inhaled antibiotics for bronchiectasis: are we there yet?" Current Pulmonology Reports 4, no. 4 (September 9, 2015): 198–204. http://dx.doi.org/10.1007/s13665-015-0126-4.

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Xu, Meng-Jiao, and Bing Dai. "Inhaled antibiotics therapy for stable non-cystic fibrosis bronchiectasis: a meta-analysis." Therapeutic Advances in Respiratory Disease 14 (January 2020): 175346662093686. http://dx.doi.org/10.1177/1753466620936866.

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Background: The optimum antibiotic therapy for non-cystic fibrosis bronchiectasis (NCFB) has yet to be determined. A meta-analysis was conducted to evaluate the efficacy and safety of inhaled antibiotics in adults with stable NCFB. Methods: PubMed, EMBASE, MEDLINE and the Cochrane Central Register of Controlled Trials were searched through November 2019. Results: A total of 16 randomized controlled trials (RCTs), recruiting 2748 NCFB patients, were finally included. Inhaled antibiotics treatment significantly reduced the sputum bacterial load [standard mean difference (SMD) = –0.74, 95% CI: –1.16–0.32, p < 0.001, I2 = 68.1%], prolonged median time [hazard risk (HR) = 0.73, 95% confidence interval (CI): 0.57–0.93, p < 0.001, I2 = 53.6%] and reduced frequency [incidence rate ratio (IRR) = 0.74, 95% CI 0.63–0.87, p < 0.001, I2 = 20.5%] of exacerbations, with good tolerance. However, it failed to improve Pseudomonas aeruginosa eradication, [forced expiratory volume in 1 s (FEV1)] % predicted, quality of life questionnaire (QoL-B) and St. George’s respiratory questionnaire (SGRQ) scores, and may induce higher risk of P. aeruginosa resistance. Subgroup analysis showed Ciprofloxacin was more effective than other antibiotics in reducing bacterial load (SMD = –1.35, 95% CI: –1.85–0.85, I2 = 63.4%, p = 0.042). Conclusion: Inhaled antibiotics therapy holds great promise for stable NCFB as it is effective in reducing sputum bacterial load and the risk of acute attack, delaying disease progression, and is well tolerated. Although this study brings some constructive ideas in the field of clinical medication, further clinical trials should be carried out, particularly in solving drug-resistance and improving health-related quality of life (HRQoL), which we believe will finally provide benefits for patients suffering from bronchiectasis. The reviews of this paper are available via the supplemental material section.

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Dogru, Deniz, Songul Yalcin, Gokcen Tugcu, Ebru Yalcin, Ugur Ozcelik, Saniye Ekinci, Nural Kiper, and Nagehan Emiralioglu. "Impact of Surgery on Growth, Pulmonary Functions, and Acute Pulmonary Exacerbations in Children with Non-Cystic Fibrosis Bronchiectasis." Thoracic and Cardiovascular Surgeon 67, no. 01 (December 12, 2017): 058–66. http://dx.doi.org/10.1055/s-0037-1608922.

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Background Treatment decisions for the management of bronchiectasis include medical treatment, such as antibiotics, chest physiotherapy, and surgical procedures. Here, we aimed to review the effect of lung resection on longitudinal growth, clinical course of patients depending on annual exacerbation rates, and pulmonary function tests (PFTs) and compare them with the results of only medically treated children with non-cystic fibrosis (non-CF) bronchiectasis. Methods The medical records of patients with non-CF bronchiectasis were retrospectively analyzed. Patients who underwent lobectomy/segmentectomy/pneumonectomy were categorized as “surgery group” (n = 29). Age- and gender-matched patients who were only medically treated were selected as “medical group” (n = 33). Annual data of patients were included till the end of postoperative second year in the surgery group and third year of medical treatment in the medical group. Results Mean baseline height z-score was lower in the surgery group, and mean baseline PFT values were all lower in the surgery group than those in the medical group (p < 0.05). In the surgery group, mean values of height z-score were –1.68 ± 0.92 at the time of surgery and improved to –1.42 ± 1.22 and –1.34 ± 1.05 in the first and second postoperative years, respectively, and annual intravenous antibiotic requirements decreased significantly (p < 0.05); however, mean body mass index (BMI) z-score values and PFT parameters did not change significantly. In the medical group, height z-score mean values and PFT parameters showed nonsignificant improvement but annual exacerbation frequency, annual intravenous, and oral antibiotic requirements decreased significantly. Conclusion Surgical management of non-CF bronchiectasis has no significant effect on BMI z-scores, annual exacerbation frequencies, oral antibiotic requirements and lung function tests; but can lead to significant improvement on height z-scores and decrease need of annual intravenous antibiotic requirements for acute severe exacerbations despite small number of patients in this study.

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Diel, Roland, James D. Chalmers, Klaus F. Rabe, Albert Nienhaus, Robert Loddenkemper, and Felix C. Ringshausen. "Economic burden of bronchiectasis in Germany." European Respiratory Journal 53, no. 2 (December 5, 2018): 1802033. http://dx.doi.org/10.1183/13993003.02033-2018.

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Estimates of healthcare costs for incident bronchiectasis patients are currently not available for any European country.Out of a sample of 4 859 013 persons covered by German statutory health insurance companies, 231 new bronchiectasis patients were identified in 2012. They were matched with 685 control patients by age, sex and Charlson Comorbidity Index, and followed for 3 years.The total direct expenditure during that period per insured bronchiectasis patient was EUR18 634.57 (95% CI EUR15 891.02–23 871.12), nearly one-third higher (ratio of mean 1.31, 95% CI 1.02–1.68) than for a matched control (p<0.001). Hospitalisation costs contributed to 35% of the total and were >50% higher in the bronchiectasis group (ratio of mean 1.56, 95% CI 1.20–3.01; p<0.001); on average, bronchiectasis patients spent 4.9 (95% CI 2.27–7.43) more days in hospital (p<0.001). Antibiotics expenditures per bronchiectasis outpatient (EUR413.81) were nearly 5 times higher than those for a matched control (ratio of mean 4.85, 95% CI 2.72–8.64). Each bronchiectasis patient had on average 40.5 (95% CI 17.1–43.5) sick-leave days and induced work-loss costs of EUR4230.49 (95% CI EUR2849.58–5611.20). The mortality rate for bronchiectasis and matched non-bronchiectasis patients after 3 years of follow-up was 26.4% and 10.5%, respectively (p<0.001). Mortality in the bronchiectasis group was higher among those who also had chronic obstructive lung disease than in patients with bronchiectasis alone (35.9% and 14.6%, respectively; p<0.001).Although bronchiectasis is considered underdiagnosed, the mortality and associated financial burden in Germany are substantial.

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Mandal, P., M. K. Sidhu, L. S. Donaldson, J. D. Chalmers, M. P. Smith, K. Turnbull, J. Scott, and A. T. Hill. "Eight-weekly intravenous antibiotics is beneficial in severe bronchiectasis." QJM 106, no. 1 (September 27, 2012): 27–33. http://dx.doi.org/10.1093/qjmed/hcs173.

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Grimwood, Keith, and Anne B. Chang. "A new dawn: inhaled antibiotics for patients with bronchiectasis." Lancet Respiratory Medicine 7, no. 3 (March 2019): 188–89. http://dx.doi.org/10.1016/s2213-2600(18)30456-9.

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Tay, George, David Reid, and Scott Bell. "Inhaled Antibiotics in Cystic Fibrosis (CF) and Non-CF Bronchiectasis." Seminars in Respiratory and Critical Care Medicine 36, no. 02 (March 31, 2015): 267–86. http://dx.doi.org/10.1055/s-0035-1547346.

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Goyal, V., K. Grimwood, J. Marchant, I. B. Masters, and A. B. Chang. "Does failed chronic wet cough response to antibiotics predict bronchiectasis?" Archives of Disease in Childhood 99, no. 6 (February 12, 2014): 522–25. http://dx.doi.org/10.1136/archdischild-2013-304793.

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Amaro, Rosanel, Meropi Panagiotarakou, Victoria Alcaraz, and Antoni Torres. "The efficacy of inhaled antibiotics in non-cystic fibrosis bronchiectasis." Expert Review of Respiratory Medicine 12, no. 8 (July 25, 2018): 683–91. http://dx.doi.org/10.1080/17476348.2018.1500179.

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Martínez-García, Miguel Ángel, Grace Oscullo, Esther Barreiro, Selene Cuenca, Angela Cervera, Alicia Padilla-Galo, David de la Rosa, et al. "Inhaled Dry Powder Antibiotics in Patients with Non-Cystic Fibrosis Bronchiectasis: Efficacy and Safety in a Real-Life Study." Journal of Clinical Medicine 9, no. 7 (July 21, 2020): 2317. http://dx.doi.org/10.3390/jcm9072317.

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Background: Nebulised antibiotics are habitually used in patients with bronchiectasis, but the use of dry powder inhaled antibiotics (DPIA) in these patients is extremely limited. This study seeks to analyse the efficacy and safety of DPIA in bronchiectasis patients. Material and methods: Multi-centre study of historic cohorts. All the hospital centres in Spain were contacted in order to collect data on patients with a diagnosis of bronchiectasis who had taken at least one dose of DPIA. Its efficacy was analysed in clinical, functional and microbiological terms by comparing the year before and the year after the prescription of DPIA. Adverse effects and variables associated with these effects, or any need to withdraw the drug, were also analysed. Results: 164 patients from 33 Spanish centres were included; 86% and 14% of these were treated with dry powder colistin and tobramycin, respectively. Chronic bronchial infection by Pseudomonas aeruginosa was present in 86% of these patients, and DPIA significantly reduced the number of exacerbations, the quantity and purulence of sputum and the isolation of pathogenic microorganisms. The most common adverse effect was cough (40%), particularly in cases of Chronic Obstructive Pulmonary Disease (COPD) and a previous cough and in those patients who had difficulties in handling the device. These factors were associated with a higher level of withdrawal of the treatment. There were no serious adverse effects. Conclusions: Our study suggests that DPIA are clinically efficacious and safe for treating bronchiectasis patients. Cough was shown to be the most common side-effect and reason for withdrawal of the treatment.

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Brodt, A. M., E. Stovold, and L. Zhang. "Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review." European Respiratory Journal 44, no. 2 (June 12, 2014): 382–93. http://dx.doi.org/10.1183/09031936.00018414.

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Rubanik, T. V., I. Yu Kroshkina, N. L. Shaporova, V. I. Trophimov, G. R. Sergeeva, O. I. Krasnoshekova, and O. A. Aleshina. "Analysis of efficiency of outpatient antibiotic therapy of respiratory diseases." PULMONOLOGIYA, no. 2 (April 28, 2005): 73–77. http://dx.doi.org/10.18093/0869-0189-2005-0-2-73-77.

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The aim of this study was to analyze the rationality of antibiotics administration and choice in patients with different respiratory diseases referred from outpatient departments to the city diagnostic center № 1 at Saint Petersburg. Two hundred and thirty five outpatient medical histories were analyzed. We revealed cases of unreasonable (in patients with bronchial asthma and exogenous allergic alveolitis) and irrational antibiotic administration (rare administration of inhibitor protected aminopenicillins, cefuroxime axetil, respiratory quinolones; use of aminoglycozides, co trimoxazolе and tetracyclines in therapeutic patients). Elderly and senile age, smoking and post tuberculotic lung pathology provided lingering pneumonia course. Eighteen patients with uncomplicated pneumonia (including lingering variants), exacerbation of chronic bronchitis and bronchiectasis were successfully treated by sparfloxacin.

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Jirru, Ermias, and Dana Zappetti. "The Prophylactic Use of Macrolide Antibiotics to Prevent Acute Exacerbations in Bronchiectasis." Clinical Pulmonary Medicine 27, no. 1 (January 2020): 37–38. http://dx.doi.org/10.1097/cpm.0000000000000341.

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Nadig, Tejaswi, and Patrick Flume. "Characteristics of Patients With Non-CF Bronchiectasis Successfully Treated With Inhaled Antibiotics." Chest 148, no. 4 (October 2015): 668A. http://dx.doi.org/10.1378/chest.2235540.

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Ip, M., D. Shum, I. Lauder, W. K. Lam, and S. Y. So. "Effect of antibiotics on sputum inflammatory contents in acute exacerbations of bronchiectasis." Respiratory Medicine 87, no. 6 (August 1993): 449–54. http://dx.doi.org/10.1016/0954-6111(93)90072-8.

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Coolen-Allou, Nathalie, Thomas Touron, Olivier Belmonte, Virgile Gazaille, Michel Andre, Jérôme Allyn, Sandrine Picot, Annabelle Payet, and Nicolas Veziris. "Clinical, Radiological, and Microbiological Characteristics of Mycobacterium simiae Infection in 97 Patients." Antimicrobial Agents and Chemotherapy 62, no. 7 (May 14, 2018): e00395-18. http://dx.doi.org/10.1128/aac.00395-18.

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ABSTRACT Mycobacterium simiae is a rare species of slow-growing nontuberculous mycobacteria (NTM). From 2002 to 2017, we conducted a retrospective study that included all patients with NTM-positive respiratory samples detected in two university hospitals of the French overseas department of Reunion Island. We recorded the prevalence of M. simiae in this cohort, as well as the clinical, radiological, and microbiological features of patients with at least 1 sample positive for M. simiae. In our cohort, 97 patients (15.1%) were positive for M. simiae. Twenty-one patients (21.6%) met the American Thoracic Society (ATS) criteria for infection. M. simiae infection was associated with bronchiectasis, micronodular lesions, and weight loss. Antibiotic susceptibility testing was performed for 60 patients, and the isolates were found to have low susceptibility to antibiotics, except for amikacin, fluoroquinolones, and clarithromycin. Treatment failed for 4 of the 8 patients treated for M. simiae infection. Here, we describe a specific cluster corresponding to a large cohort of patients with M. simiae, a rare nontuberculous mycobacterium associated with low pathogenicity and poor susceptibility to antibiotics.

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Chad, Thomas, and Jeremy Brown. "Chronic cough in a patient with stable ulcerative colitis: a rare but important extraintestinal manifestation of inflammatory bowel disease." BMJ Case Reports 12, no. 1 (January 2019): bcr—2018–227066. http://dx.doi.org/10.1136/bcr-2018-227066.

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A 74-year-old woman presented to her general practitioner with cough and occasional sputum production. Having failed to respond to courses of antibiotics in the community, she was referred to the thoracic medicine clinic. High-resolution CT chest revealed cylindrical bronchiectasis predominantly in the right lower lobe. Lung function revealed preserved FEV1 and FVC but reduced gas transfer values. Bronchiectasis secondary to ulcerative colitis was diagnosed. Inhaled corticosteroid therapy was initiated, with good clinical response noted at 6 monthly follow-up. Remission was sustained with tapering of the steroid dose. Recognition of respiratory complications in cases of inflammatory bowel disease is likely still poor among clinicians. Although rare, a working knowledge of principles of investigation and management will aid timely diagnosis and treatment, potentially preventing progression of respiratory disease.

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Crichton, Megan L., Mike Lonergan, Alan F. Barker, Oriol Sibila, Pieter Goeminne, Amelia Shoemark, and James D. Chalmers. "Inhaled aztreonam improves symptoms of cough and sputum production in patients with bronchiectasis: a post hoc analysis of the AIR-BX studies." European Respiratory Journal 56, no. 1 (April 7, 2020): 2000608. http://dx.doi.org/10.1183/13993003.00608-2020.

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IntroductionInhaled antibiotics may improve symptom scores, but it is not known which specific symptoms improve with therapy. Item-level analysis of questionnaire data may allow us to identify which specific symptoms respond best to treatment.MethodsPost hoc analysis of the AIR-BX1 studies and two trials of inhaled aztreonam versus placebo in bronchiectasis. Individual items from the quality of life bronchiectasis (QOL-B) respiratory symptom scale, were extracted as representing severity of nine distinct symptoms. Generalised linear models were used to evaluate changes in symptoms with treatment versus placebo from baseline to end of first on-treatment cycle and mixed models were used to evaluate changes across the full 16-week trial.ResultsAztreonam improved cough (difference 0.22, 95% CI 0.08–0.37; p=0.002), sputum production (0.30, 95% CI 0.15–0.44; p<0.0001) and sputum colour (0.29, 95% CI 0.15–0.43; p<0.0001) versus placebo equating to a 20% improvement in cough and 25% improvement in sputum production and colour. Similar results were observed for cough, sputum production and sputum purulence across the trial duration (all p<0.05). Patients with higher sputum production and sputum colour scores had a greater response on the overall QOL-B (difference 4.82, 95% CI 1.12–8.53; p=0.011 for sputum production and 5.02, 95% CI 1.19–8.86; p=0.01 for sputum colour). In contrast, treating patients who had lower levels of bronchitic symptoms resulted in shorter time to next exacerbation (hazard ratio 1.83, 95% CI 1.02–3.28; p=0.042).ConclusionBaseline bronchitic symptoms predict response to inhaled aztreonam in bronchiectasis. More sensitive tools to measure bronchitic symptoms may be useful to better identify inhaled antibiotic responders and to evaluate patient response to treatment.

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Karampitsakos, Theodoros, Ourania Papaioannou, Maria Kaponi, Andreana Kozanidou, Georgios Hillas, Elisavet Stavropoulou, Demosthenes Bouros, and Katerina Dimakou. "Low penetrance of antibiotics in the epithelial lining fluid. The role of inhaled antibiotics in patients with bronchiectasis." Pulmonary Pharmacology & Therapeutics 60 (February 2020): 101885. http://dx.doi.org/10.1016/j.pupt.2019.101885.

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Chang, Anne B., Siew Moy Fong, Tsin Wen Yeo, Robert S. Ware, Gabrielle B. McCallum, Anna M. Nathan, Mong H. Ooi, et al. "HOspitalised Pneumonia Extended (HOPE) Study to reduce the long-term effects of childhood pneumonia: protocol for a multicentre, double-blind, parallel, superiority randomised controlled trial." BMJ Open 9, no. 4 (April 2019): e026411. http://dx.doi.org/10.1136/bmjopen-2018-026411.

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IntroductionEarly childhood pneumonia is a common problem globally with long-term complications that include bronchiectasis and chronic obstructive pulmonary disease. It is biologically plausible that these long-term effects may be minimised in young children at increased risk of such sequelae if any residual lower airway infection and inflammation in their developing lungs can be treated successfully by longer antibiotic courses. In contrast, shortened antibiotic treatments are being promoted because of concerns over inducing antimicrobial resistance. Nevertheless, the optimal treatment duration remains unknown. Outcomes from randomised controlled trials (RCTs) on paediatric pneumonia have focused on short-term (usually <2 weeks) results. Indeed, no long-term RCT-generated outcome data are available currently. We hypothesise that a longer antibiotic course, compared with the standard treatment course, reduces the risk of chronic respiratory symptoms/signs or bronchiectasis 24 months after the original pneumonia episode.Methods and analysisThis multicentre, parallel, double-blind, placebo-controlled randomised trial involving seven hospitals in six cities from three different countries commenced in May 2016. Three-hundred-and-fourteen eligible Australian Indigenous, New Zealand Māori/Pacific and Malaysian children (aged 0.25 to 5 years) hospitalised for community-acquired, chest X-ray (CXR)-proven pneumonia are being recruited. Following intravenous antibiotics and 3 days of amoxicillin-clavulanate, they are randomised (stratified by site and age group, allocation-concealed) to receive either: (i) amoxicillin-clavulanate (80 mg/kg/day (maximum 980 mg of amoxicillin) in two-divided doses or (ii) placebo (equal volume and dosing frequency) for 8 days. Clinical data, nasopharyngeal swab, bloods and CXR are collected. The primary outcome is the proportion of children without chronic respiratory symptom/signs of bronchiectasis at 24 months. The main secondary outcomes are ‘clinical cure’ at 4 weeks, time-to-next respiratory-related hospitalisation and antibiotic resistance of nasopharyngeal respiratory bacteria.Ethics and disseminationThe Human Research Ethics Committees of all the recruiting institutions (Darwin: Northern Territory Department of Health and Menzies School of Health Research; Auckland: Starship Children’s and KidsFirst Hospitals; East Malaysia: Likas Hospital and Sarawak General Hospital; Kuala Lumpur: University of Malaya Research Ethics Committee; and Klang: Malaysian Department of Health) have approved the research protocol version 7 (13 August 2018). The RCT and other results will be submitted for publication.Trial registrationACTRN12616000046404.

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Vendrell, Montserrat, Gerard Muñoz, and Javier de Gracia. "Evidence of Inhaled Tobramycin in Non-Cystic Fibrosis Bronchiectasis." Open Respiratory Medicine Journal 9, no. 1 (March 31, 2015): 30–36. http://dx.doi.org/10.2174/1874306401509010030.

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There is currently less experience with inhaled tobramycin in non-cystic fibrosis bronchiectasis than in cystic fibrosis (CF). Intravenous formulation and solution for inhalation (TSI) have been studied in non-CF bronchiectasis patients with chronic P. aeruginosa bronchial infection. An improvement in clinical parameters and a reduction in bacterial density have been shown with both inhaled solutions in these patients. However, further trials are needed to determine the most effective dose and administration protocol in these patients. Based on the current evidence, recommendations cannot be made regarding the use of TSI to treat exacerbations. Although no systemic toxicity has been reported in studies specifically investigating this treatment, patients with known kidney disease or ear disorders should be treated with caution. Adverse respiratory effects are reported to be more common in non-CF patients than in CF patients, who tend to be non-smokers and younger. Research is being conducted into the possibility of combining tobramycin with other antibiotics to increase its antibacterial activity. In this review we will present and discuss the published evidence regarding the use of inhaled tobramycin in non–CF bronchiectasis.

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Carmona Oyaga, P., G. Liceaga Cundin, MJ Gayan Lera, I. Aguirre Zubia, K. Andueza Granados, MD Mauleon Echeverria, L. Lombera Saez, L. Leunda Eizmendi, E. Pagés Romero, and A. Algaba Las Peñas. "DI-020 Patient-reported outcomes during prophylaxis with inhaled antibiotics for fibrosis bronchiectasis." European Journal of Hospital Pharmacy 21, Suppl 1 (February 24, 2014): A78.1—A78. http://dx.doi.org/10.1136/ejhpharm-2013-000436.191.

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Singh, KV, A. Sahal, and A. Sullivan. "P107 Implications of Adverse Drug Reactions to Antibiotics in the Management of Bronchiectasis." Thorax 68, Suppl 3 (November 14, 2013): A122.3—A123. http://dx.doi.org/10.1136/thoraxjnl-2013-204457.257.

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Fan, Li-Chao, Jie-Lu Lin, Jia-Wei Yang, Bei Mao, Hai-Wen Lu, Bao-Xue Ge, Augustine M. K. Choi, and Jin-Fu Xu. "Macrolides protect against Pseudomonas aeruginosa infection via inhibition of inflammasomes." American Journal of Physiology-Lung Cellular and Molecular Physiology 313, no. 4 (October 1, 2017): L677—L686. http://dx.doi.org/10.1152/ajplung.00123.2017.

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Macrolides antibiotics have been effectively used in many chronic diseases, especially with Pseudomonas aeruginosa (P. aeruginosa) infection. The mechanisms underlying the therapeutic effects of macrolides in these diseases remain poorly understood. We established a mouse model of chronic lung infection using P. aeruginosa agar-beads, with azithromycin treatment or placebo. Lung injury, bacterial clearance, and inflammasome-related proteins were measured. In vitro, the inflammasomes activation induced by flagellin or ATP were assessed in LPS-primed macrophages with or without macrolides treatment. Plasma IL-18 levels were determined from patients who were diagnosed with bronchiectasis isolated with or without P. aeruginosa and treated with azithromycin for 3–5 days. Azithromycin treatment enhanced bacterial clearance and attenuated lung injury in mice chronically infected with P. aeruginosa, which resulted from the inhibition of caspase-1-dependent IL-1β and IL-18 secretion. In vitro, azithromycin and erythromycin inhibited NLRC4 and NLRP3 inflammasomes activation. Plasma IL-18 levels were higher in bronchiectasis patients with P. aeruginosa isolation compared with healthy controls. Azithromycin administration markedly decreased IL-18 secretion in bronchiectasis patients. The results of this study reveal that azithromycin and erythromycin exert a novel anti-inflammatory effect by attenuating inflammasomes activation, which suggests potential treatment options for inflammasome-related diseases.

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Awadh, Hesham, Munthir Mansour, Obadah Aqtash, and Yousef Shweihat. "Pneumonia due to a Rare Pathogen: Achromobacter xylosoxidans, Subspecies denitrificans." Case Reports in Infectious Diseases 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/3969682.

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Achromobacter xylosoxidans, subspecies denitrificans, is a gram-negative rod recently implicated as an emerging cause of infection in both immunosuppressed and immunocompetent populations. Few cases are reported in literature involving multiple body systems. Diagnosis depends on cultures of appropriate specimens, and management usually is by administration of appropriate antibiotics (usually agents with antipseudomonal activity). We report a rare case of pneumonia due to infection with this organism, in a patient with preexisting bronchiectasis secondary to chronic aspiration.

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Evans, D. J., and M. Greenstone. "Long-term antibiotics in the management of non-CF bronchiectasis—do they improve outcome?" Respiratory Medicine 97, no. 7 (July 2003): 851–58. http://dx.doi.org/10.1016/s0954-6111(03)00063-5.

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Barto, Tara Lynn, Diego Jose Maselli, Sarah Daignault, John Stiglich, Jared Porter, Carlye Kraemer, and Gary Hansen. "Real-life experience with high-frequency chest wall oscillation vest therapy in adults with non-cystic fibrosis bronchiectasis." Therapeutic Advances in Respiratory Disease 14 (January 2020): 175346662093250. http://dx.doi.org/10.1177/1753466620932508.

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Background: High frequency chest wall oscillation (HFCWO) has long been used for airway clearance for patients with cystic fibrosis. Only limited research has evaluated this therapy in adult patients with non-cystic fibrosis bronchiectasis (NCFB). Methods: Data from 2596 patients from a registry of adult bronchiectasis patients using HFCWO therapy was used to evaluate hospitalization patterns before and after initiation of HFCWO therapy, as well as antibiotic use and self-reported metrics of quality of life. Self-reported outcomes were also reviewed by cross-checking with sampled patient charts and found to be consistent. Results: The number of patients who had at least one respiratory-related hospitalization decreased from 49.1% (192/391) in the year before to 24.0% (94/391) in the year after starting HFCWO therapy ( p-value < 0.001). At the same time, the number of patients who required three or more hospitalizations dropped from 14.3% (56/391) to 5.6% (22/391). Patients currently taking oral antibiotics for respiratory conditions decreased from 57.7% upon initiation of therapy to 29.9% within 1 year ( p < 0.001). Patients who subjectively rated their “overall respiratory health” as good to excellent increased from 13.6% upon initiation of therapy to 60.5% in 1 year ( p < 0.001) and those who rated their “ability to clear your lungs” as good to excellent increased from 13.9% to 76.6% ( p < 0.001). Conclusion: NCFB patients showed improved self-reported outcomes associated with the initiation of HFCWO therapy as measured by number of hospitalizations, antibiotic use, and the subjective experience of airway clearance. The improvement was observed early on after initiation of therapy and sustained for at least 1 year. The reviews of this paper are available via the supplemental material section.

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Sugianto, Tiffanie Daisy, and Hak-Kim Chan. "Inhaled antibiotics in the treatment of non-cystic fibrosis bronchiectasis: clinical and drug delivery perspectives." Expert Opinion on Drug Delivery 13, no. 1 (August 12, 2015): 7–22. http://dx.doi.org/10.1517/17425247.2015.1078309.

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Rojony, Rajoana, Lia Danelishvili, Anaamika Campeau, Jacob M. Wozniak, David J. Gonzalez, and Luiz E. Bermudez. "Exposure of Mycobacterium abscessus to Environmental Stress and Clinically Used Antibiotics Reveals Common Proteome Response among Pathogenic Mycobacteria." Microorganisms 8, no. 5 (May 9, 2020): 698. http://dx.doi.org/10.3390/microorganisms8050698.

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Mycobacterium abscessus subsp. abscessus (MAB) is a clinically important nontuberculous mycobacterium (NTM) causing pulmonary infection in patients such as cystic fibrosis and bronchiectasis. MAB is naturally resistant to the majority of available antibiotics. In attempts to identify the fundamental response of MAB to aerobic, anaerobic, and biofilm conditions (as it is encountered in patients) and during exposure to antibiotics, we studied bacterial proteome using tandem mass tag mass spectrometry sequencing. Numerous de novo synthesized proteins belonging to diverse metabolic pathways were found in anaerobic and biofilm conditions, including glycolysis/gluconeogenesis, tricarboxylic acid (TCA) cycle, oxidative phosphorylation, nitrogen metabolism, and glyoxylate and dicarboxylate metabolism. Upon exposure to amikacin and linezolid under stress environments, MAB displayed metabolic enrichment for glycerophospholipid metabolism and oxidative phosphorylation. By comparing proteomes of two significant NTMs, MAB and M. avium subsp. hominissuis, we found highly synthesized shared enzymes of oxidative phosphorylation, TCA cycle, glycolysis/gluconeogenesis, glyoxylate/dicarboxylate, nitrogen metabolism, peptidoglycan biosynthesis, and glycerophospholipid/glycerolipid metabolism. The activation of peptidoglycan and fatty acid biosynthesis pathways indicates the attempt of bacteria to modify the cell wall, influencing the susceptibility to antibiotics. This study establishes global changes in the synthesis of enzymes promoting the metabolic shift and enhancing the pathogen resistance to antibiotics within different environments.

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Loebinger, Michael R., Eva Polverino, James D. Chalmers, Harm A. W. M. Tiddens, Herman Goossens, Michael Tunney, Felix C. Ringshausen, et al. "Efficacy and safety of TOBI Podhaler in Pseudomonas aeruginosa-infected bronchiectasis patients: iBEST study." European Respiratory Journal 57, no. 1 (August 27, 2020): 2001451. http://dx.doi.org/10.1183/13993003.01451-2020.

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The study aimed to determine the efficacy of a safe and well-tolerated dose and regimen of tobramycin inhalation powder (TIP) on Pseudomonas aeruginosa sputum density in patients with bronchiectasis.This is a phase II, double-blind, randomised study in bronchiectasis patients aged ≥18 years with chronic P. aeruginosa infection. Patients were randomised 1:1:1 to either cohort A: three capsules of TIP once daily (84 mg); cohort B: five capsules once daily (140 mg) or cohort C: four capsules twice daily (224 mg). Within each cohort, patients were further randomised 2:2:1 either to TIP continuously, TIP cyclically (alternating 28 days of TIP and placebo) or placebo for 16 weeks, respectively and were followed up for 8 weeks.Overall, 107 patients were randomised to cohorts A (n=34), B (n=36) and C (n=37). All three TIP doses significantly reduced the P. aeruginosa sputum density from baseline to day 29 versus placebo in a dose-dependent manner (p≤0.0001, each). A smaller proportion of patients in the continuous-TIP (34.1%) and cyclical-TIP (35.7%) groups experienced pulmonary exacerbations versus placebo (47.6%) and also required fewer anti-pseudomonal antibiotics (38.6% on continuous TIP and 42.9% on cyclical TIP) versus placebo (57.1%) although not statistically significant. Pulmonary exacerbation of bronchiectasis was the most frequent (37.4%) adverse event. Overall, TIP was well tolerated, however, 23.4% of the patients discontinued the study drug due to adverse events.Continuous- and cyclical-TIP regimens with all three doses were safe and effective in reducing the P. aeruginosa sputum density in patients with bronchiectasis and chronic P. aeruginosa infection.

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Shoemark, Amelia, and Katharine Harman. "Primary Ciliary Dyskinesia." Seminars in Respiratory and Critical Care Medicine 42, no. 04 (July 14, 2021): 537–48. http://dx.doi.org/10.1055/s-0041-1730919.

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AbstractPrimary ciliary dyskinesia (PCD) is an inherited cause of bronchiectasis. The estimated PCD prevalence in children with bronchiectasis is up to 26% and in adults with bronchiectasis is 1 to 13%. Due to dysfunction of the multiple motile cilia of the respiratory tract patients suffer from poor mucociliary clearance. Clinical manifestations are heterogeneous; however, a typical patient presents with chronic productive cough and rhinosinusitis from early life. Other symptoms reflect the multiple roles of motile cilia in other organs and can include otitis media and hearing loss, infertility, situs inversus, complex congenital heart disease, and more rarely other syndromic features such as hydrocephalus and retinitis pigmentosa. Awareness, identification, and diagnosis of a patient with PCD are important for multidisciplinary care and genetic counseling. Diagnosis can be pursued through a multitest pathway which includes the measurement of nasal nitric oxide, sampling the nasal epithelium to assess ciliary function and structure, and genotyping. Diagnosis is confirmed by the identification of a hallmark ultrastructural defect or pathogenic mutations in one of > 45 PCD causing genes. When a diagnosis is established management is centered around improving mucociliary clearance through physiotherapy and treatment of infection with antibiotics. The first international randomized controlled trial in PCD has recently been conducted showing azithromycin is effective in reducing exacerbations. It is likely that evidence-based PCD-specific management guidelines and therapies will be developed in the near future. This article examines prevalence, clinical features, diagnosis, and management of PCD highlighting recent advances in basic science and clinical care.

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Severiche-Bueno, Diego, Enrique Gamboa, Luis F. Reyes, and Sanjay H. Chotirmall. "Hot topics and current controversies in non-cystic fibrosis bronchiectasis." Breathe 15, no. 4 (December 2019): 286–95. http://dx.doi.org/10.1183/20734735.0261-2019.

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Non-cystic fibrosis bronchiectasis (NCFB) is a neglected and orphan disease with poor advances through the 20th century. However, its prevalence is rising and with this come new challenges for physicians. Few guidelines are available to guide clinicians on how to diagnose and manage patients with NCFB. Many areas of debate persist, and there is lack of consensus about research priorities most needed to advance patient care and improve clinical outcomes. In this review, we highlight the current hot topics in NCFB and present updated evidence to inform the critical areas of controversy.Key pointsPostural drainage, active cycle of breathing techniques and pulmonary rehabilitation are non-pharmacological treatment options that should be offered to all patients with non-cystic fibrosis bronchiectasis (NCFB).Eradication of Pseudomonas aeruginosa (PA) colonisation in patients without an acute exacerbation remains debatable.Sputum cultures are the leading and most readily available tool to detect patients with chronic colonisation by PA and should be performed in all patients with NCFB.Antibacterial monoclonal antibodies and vaccine studies have shown promising results in the prevention of chronic colonisation with PA and should stimulate new studies in NCFB.NCFB patients colonised with PA are at more risk of a rapid decline in lung function, worsening quality of life and more hospital admissions.Dual therapy is a promising option for the management of patients with PA-related exacerbations.Patients with PA-related exacerbations benefit from prolonged courses of antibiotics (i.e. 14 days) but emerging and future studies, including dual therapy, may show promising results with shorter courses.Endophenotyping bronchiectasis to address its inherent heterogeneity is a promising avenue for future investment and research.

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Chalmers, James D., David Cipolla, Bruce Thompson, Angela M. Davis, Anne O'Donnell, Gregory Tino, Igor Gonda, Charles Haworth, and Juergen Froehlich. "Changes in respiratory symptoms during 48-week treatment with ARD-3150 (inhaled liposomal ciprofloxacin) in bronchiectasis: results from the ORBIT-3 and -4 studies." European Respiratory Journal 56, no. 4 (June 18, 2020): 2000110. http://dx.doi.org/10.1183/13993003.00110-2020.

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It is not known if inhaled antibiotics improve respiratory symptoms in patients with bronchiectasis. In the recent phase-3 ORBIT trials, 48 weeks' treatment with ARD-3150 (inhaled liposomal ciprofloxacin) did not significantly improve symptoms using the prespecified method of analysis comparing baseline symptoms to those after 48 weeks, when patients had been off treatment for 28 days. This method of analysis does not take account of possible improvements in symptoms while on active treatment.A post hoc analysis of two identical randomised trials of ARD-3150 (ORBIT-3 and -4) administered 28 days on and 28 days off in patients with bronchiectasis and chronic Pseudomonas aeruginosa infection. The quality-of-life bronchiectasis respiratory symptom scale (QOL-B-RSS), which has a one-week recall period, was administered every 28 days. We examined whether respiratory symptoms improved during on-treatment periods and the relationship of changes in QOL-B-RSS to changes in bacterial load using a mixed-model repeated measures approach.ARD-3150 treatment resulted in a significant improvement in respiratory symptoms during the on-treatment periods with concordant results between ORBIT-3 (estimate 1.4 points, se 0.49; p=0.004) and ORBIT-4 (estimate 1.1 point, se 0.41; p=0.006). The proportion of patients achieving a symptom improvement above the minimum clinically important difference was higher with ARD-3150 compared with placebo during on-treatment cycles (p=0.024). Changes in respiratory symptoms were correlated with changes in bacterial load in the treatment group (r=−0.89, p<0.0001). Individual estimates for decrements in the QOL-B RSS during exacerbation were −9.4 points (se 0.91) in ORBIT-3 and −10.8 points (0.74) in ORBIT-4 (both p<0.0001).Inhaled ARD-3150 resulted in significant improvements in respiratory symptoms during the on-treatment periods which were lost during off-treatment periods. These results supports the concept that reducing bacterial load can improve respiratory symptoms in patients with bronchiectasis.

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Viniol, Christian, and Claus F. Vogelmeier. "Exacerbations of COPD." European Respiratory Review 27, no. 147 (March 14, 2018): 170103. http://dx.doi.org/10.1183/16000617.0103-2017.

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Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. Severe exacerbations are related to a significantly worse survival outcome. This review summarises the current knowledge on the different aspects of COPD exacerbations. The impact of risk factors and triggers such as smoking, severe airflow limitation, bronchiectasis, bacterial and viral infections and comorbidities is discussed. More severe exacerbations should be treated with β-agonists and anticholinergics as well as systemic corticosteroids. Antibiotic therapy should only be given to patients with presumed bacterial infection. Noninvasive ventilation is indicated in patients with respiratory failure. Smoking cessation is key to prevent further COPD exacerbations. Other aspects include choice of pharmacotherapy, including bronchodilators, inhaled corticosteroids, phosphodiesterase-4 inhibitors, long-term antibiotics and mucolytics. Better education and self-management as well as increased physical activity are important. Influenza and pneumococcal vaccination is recommended. Treatment of hypoxaemia and hypercapnia reduce the rate of COPD exacerbations, while most interventional bronchoscopic therapies increase exacerbation risk within the first months after the procedure.

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Journal articles on the topic 'Antibiotics and bronchiectasis'

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