Background
Bronchiectasis is a common condition arising from a cycle of repeated chest infections that damage the airways, leaving them susceptible to further infection. Typical symptoms include persistent cough and phlegm production. The main aim of treatment is to reduce lung infections and improve quality of life. Long term antibiotics aim to break this cycle of reinfection but this must be balanced against increased risk of developing resistance to antibiotics. Antibiotics may be taken at intervals to reduce this risk, but little is known about the length of intervals that may work best. This review will help people who develop clinical guidelines, doctors and people with bronchiectasis to decide whether to use antibiotics at regular intervals and the best interval duration.
Study characteristics
We found eight studies in September 2021 that looked at antibiotics given at intervals of 28 days on followed by 28 day off, or 14 days on then 14 days off, or a comparison between 14‐ and 28‐day intervals, for up to 48 weeks. The studies included 2180 adults with an average age of 63.6 years. None of the studies included children.
Key results
The intervals of 14 days on/off antibiotics slightly reduced the frequency of chest infections compared to no antibiotics. We did not find these benefits with intervals of 28 days on/off antibiotics but study participants had fewer severe chest infections. Overall, antibiotic resistance was over twice as common in people receiving antibiotics, irrespective of the intervals between doses. No certain differences were found between groups for serious adverse outcomes such as deaths or hospitalisations, other aspects of lung functioning or health‐related quality of life. There were enough people in the studies to assess the benefits and safety of treatment.
Quality of the evidence
In general, the included studies were of good quality. We had moderate to high confidence in the quality of the evidence for frequency of chest infections and occurrence of antibiotic resistance.
Conclusions
Overall, in adults who have frequent chest infections, long‐term antibiotics given at 14‐day on/off intervals slightly reduces the frequency of those infections and increases antibiotic resistance. We found little difference in the number of people who died, had to go to hospital, or had other serious problems. The benefits and safety of this type of treatment are unknown in children.
Font: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013254.pub2/full/es
