A Cochrane review [Abstract] 1 included 9 studies with a total of 378 patients. Antibiotics were given for between 4 weeks and one year. Only limited meta-analysis was possible due to the diversity of the trials. Response rates showed significant effects in favour of prolonged antibiotic treatment (Peto OR 3.37, 95% CI 1.60 to 7.09). Conversely for exacerbation rates there was no significant difference between prolonged antibiotics and placebo (OR 0.96, 95% CI 0.27 to 3.46). For withdrawals there was no significant difference between treatment and placebo management (OR 1.06, 95% CI 0.42 to 2.65). Data for lung function showed no significant benefit in favour of antibiotic treatment (% predicted FEV1 mean difference -1.05 %, 95% CI -6.93 to 4.83).
Another Cochrane review [Abstract] 2 on short courses (≤ 4 weeks) of antibiotics for bronchiectasis found one eligible study with 74 adult participants (mean age 66.6 in the intervention group and 63.2 in the placebo group) with CT confirmed bronchiectasis and Pseudomonas aeruginosa infection. There were no studies in children and no studies on oral or intravenous antibiotics. Patients received either 300 mg of inhaled tobramycin or placebo twice daily for 4 weeks. According to the investigator's subjective assessment at 6 weeks, 23 of 37 (62%) patients in the tobramycin group had significantly improved general medical condition compared to 14 of 35 (40%) in the placebo group. Percent change in FEV1 and FVC from baseline to week 4 were not statistically significant between the tobramycin and placebo groups (-2.2% versus 1.5% respectively, P = 0.41). At the end of the trial, significantly more subjects in the tobramycin group (13 of 37) had P. aeruginosa eradicated from their sputum compared to the placebo group (0 of 37); OR 0.03; 95% CI 0.01 to 0.14. Further 12 patients in the tobramycin group had reduced P. aeruginosa carriage compared to 2 patients with reduced carriage in the placebo group. Four of 36 patients in the tobramycin group and one of 32 in the placebo group, who began the study with susceptible P. aeruginosa, had resistant P. aeruginosa at their last visit (P = 0.36).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment) and by inconsistency (heterogeneity in studied interventions and outcomes).
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