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Long-term macrolide treatment for non-cystic fibrosis bronchiectasis in children: a meta-analysis

 Eun Lee  ;  In Suk Sol  ;  Jong Deok Kim  ;  Hyeon-Jong Yang  ;  Taek Ki Min  ;  Gwang Cheon Jang  ;  Yoon Ha Hwang  ;  Hyun-Ju Cho  ;  Dong In Suh  ;  Kyunghoon Kim  ;  Hwan Soo Kim  ;  Yoon Hee Kim  ;  Sung Il Woo  ;  Yong Ju Lee  ;  Sungsu Jung  ;  You Hoon Jeon 
 SCIENTIFIC REPORTS, Vol.11(1) : 24287, 2021-12 
Journal Title
Issue Date
Anti-Bacterial Agents / therapeutic use ; Azithromycin / pharmacology ; Bacterial Infections / drug therapy ; Bronchiectasis / drug therapy* ; Bronchiectasis / microbiology* ; Child ; Disease Progression ; Drug Resistance, Bacterial* ; Humans ; Macrolides / therapeutic use* ; Odds Ratio ; Protein Synthesis Inhibitors ; Quality of Life ; Randomized Controlled Trials as Topic ; Risk ; Treatment Outcome
Recurrent bacterial infection causes frequent bronchiectasis (BE) exacerbations. The effectiveness and safety of long-term administration of macrolides in BE remain controversial, especially in children who require minimal treatment to prevent exacerbation. We conducted this meta-analysis to determine the usefulness of long-term macrolide use 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) which elucidated 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 included 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], 0.10-0.87), 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 an increased carriage of azithromycin-resistant bacteria (OR, 7.13). Long-term macrolide administration prevents exacerbation of BE in children; however, there are risks of increasing antibiotic resistance. Benefits and risks should be weighed and determined on a patient-by-patient basis.
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1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yoon Hee(김윤희) ORCID logo https://orcid.org/0000-0002-2149-8501
Kim, Jong Deok(김종덕)
Lee, Yong Ju(이용주) ORCID logo https://orcid.org/0000-0002-0796-2558
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