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Duration of Antibiotic Therapy in Non-cystic Fibrosis Bronchiectasis

  • Bronchiectasis (A Schmid, Section Editor)
  • Published:
Current Pulmonology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We conducted a review of the current evidence relating to antibiotic duration in the short- and long-term management of non-cystic fibrosis bronchiectasis.

Recent Findings

In non-cystic fibrosis pulmonary exacerbations, evidence is primarily based on expert consensus and recent guidelines recommend antibiotic durations of approximately 14 days. Chronic antibiotics (oral or inhaled) are recommended in patients with frequent exacerbations or with chronic Pseudomonas aeruginosa airways infection. Macrolides are the best studied therapies for long-term use with evidence for effect limited to a 12-month duration. Encouragingly, there are increased efforts to develop registries and conduct larger population-level studies to improve patient care.

Summary

There is a paucity of evidence for optimal antibiotic strategies in exacerbations and chronic maintenance in persons with non-cystic fibrosis bronchiectasis. Rationally designed studies which utilize a registry and population-based approach will be critical to build evidence-based strategies to optimize management of non-cystic fibrosis bronchiectasis.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Chalmers J, Smith MP, McHugh BJ, Doherty C, Govan JR, Hill AT. Short- and long-term antibiotic treatment reduces airways and systemic inflammation in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2012;186(7):657–65.

    CAS  PubMed  Google Scholar 

  2. Chalmers J, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med. 2014;189:576–85.

    PubMed  PubMed Central  Google Scholar 

  3. Kapur N, Masters IB, Chang AB. Longitudinal growth and lung function in pediatric non-cystic fibrosis bronchiectasis: what influences lung function stability? Chest. 2010;138:158–64.

    PubMed  Google Scholar 

  4. Sheehan R, Wells AU, Copley SJ, Desai SR, Howling SJ, Cole PJ, et al. A comparison of serial computed tomography and functional change in bronchiectasis. Eur Respir J. 2002;20:581–7.

    CAS  PubMed  Google Scholar 

  5. Aliberti S, Lonni S, Dore S, et al. Clinical phenotype in adult patients with bronchiectasis. Eur Respir J. 2016;47:1113–22.

    PubMed  Google Scholar 

  6. •• Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017;50:1700629 This is the most recent guideline for nCFB and summarizes current evidence for management.

    PubMed  Google Scholar 

  7. Cole P. Inflammation: a two-edge sword – the model of bronchiectasis. Eur J Respir Dis. 1986;69:6–15.

    Google Scholar 

  8. Hoegger M, Fischer AJ, McMenimen JD, et al. Impaired mucus detachment disrupts mucociliary transport in a piglet model of cystic fibrosis. Science. 2014;345:818–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Pezzulo A, Tang XX, Hoegger MJ, et al. Reduced airway surface pH impairs bacterial killing in the porcine cystic fibrosis lung. Nature. 2012;487(7405):109–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. O’Donnell A. Bronchiectasis. Chest. 2008;134:815–23.

    PubMed  Google Scholar 

  11. Tunney M, Einarsson GG, Wei L, et al. Lung microbiota and bacterial abundance in patients with bronchiectasis when clinically stable and during exacerbation. Am J Respir Crit Care Med. 2013;187(10):1118–26.

    PubMed  PubMed Central  Google Scholar 

  12. Rogers G, Zain NM, Bruce KD, et al. A novel microbiota stratification system predicts future exacerbations in bronchiectasis. Ann Am Thorac Soc. 2014;11:496–503.

    PubMed  Google Scholar 

  13. Ho P, Chan KN, Ip MS, et al. The effect of Pseudomonas aeruginosa infection on clinical parameters in steady-state bronchiectasis. Chest. 1998;114(6):1594–8.

    CAS  PubMed  Google Scholar 

  14. Angrill J, Agustí C, de Celis R, et al. Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors. Thorax. 2002;57:15–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Loebinger M, Wells AU, Hansell DM, et al. Mortality in bronchiectasis: a long-term study assessing the factors influencing survival. Eur Respir J. 2009;34(4):843–9.

    CAS  PubMed  Google Scholar 

  16. Woo T, Lim R, Surette MG, et al. Epidemiology and natural history of Pseudomonas aeruginosa airway infections in non-cystic fibrosis bronchiectasis. ERJ Open Res. 2018;4:00162–2017.

    PubMed  PubMed Central  Google Scholar 

  17. De Soyza A, Perry A, Hall AJ, et al. Molecular epidemiological analysis suggests cross-infection with Pseudomonas aeruginosa is rare in non-cystic fibrosis bronchiectasis. Eur Respir J. 2014;43(3):900–3.

    PubMed  Google Scholar 

  18. •• Hill A, Haworth CS, Aliberti S, Barker A, Blasi F, Boersma W, et al. Pulmonary exacerbation in adults with bronchiectasis: a consensus definition for clinical research. Eur Respir J. 2017;49(6). This study is important as it aims to develop a standardized definition for pulmonary exacerbations specific to non-cystic fibrosis bronchiectasis.):1700051.

    PubMed  Google Scholar 

  19. Weycker D, Oster G, Tino G. Prevalence and economic burden of bronchiectasis. Clin Pulm Med. 2005;12(4):205–9.

    Google Scholar 

  20. O’Donnell A, Barker AF, Ilowite JS, et al. Treatment of idiopathic bronchiectasis with aerosolized recombinant human DNase I. Chest. 1998;113:1329–34.

    PubMed  Google Scholar 

  21. Barker A, O’Donnell AE, Flume P, et al. Aztreonam for inhalation solution in patients with non-cystic fibrosis bronchiectasis (AIR-BX1 and AIR-BX2): two randomized double-blind placebo-controlled phase 3 trials. Lancet Respir Med. 2014;2:738–49.

    CAS  PubMed  Google Scholar 

  22. Orriols R, Hernando R, Ferrer A, et al. Eradication therapy against Pseudomonas aeruginosa in non-cystic fibrosis bronchiectasis. Respiration. 2015;90:290–305.

    Google Scholar 

  23. Orriols R, Roe J. Inhaled antibiotic therapy in non-cystic fibrosis patients with bronchiectasis and chronic bronchial infection by Pseudomonas aeruginosa. Respir Med. 1999;93:476–80.

    CAS  PubMed  Google Scholar 

  24. White L, Mirrani G, Grover M, et al. Outcomes of Pseudomonas eradication therapy in patients with non-cystic fibrosis bronchiectasis. Respir Med. 2012;106:356–60.

    PubMed  Google Scholar 

  25. •• Chalmers J, Aliberti S, Polverino E, et al. The EMBARC European Bronchiectasis registy: protocol for an international observational study. ERJ Open Res. 2016;2. This study is important as it is an effort to develop population-based studies to better understand and manage non-cystic fibrosis bronchiectasis.:00081–2015.

    PubMed  PubMed Central  Google Scholar 

  26. Vendrell M, de Gracia J, Olveira C, Martinez-Garcia MA, Girón R, Máiz L, et al. Normativa SEPAR: diagnostico y tratamiento de las bronquiectasias. Arch Bronconeumol. 2008;44:629–40.

    PubMed  Google Scholar 

  27. Pasteur M, Bilton D, Hill AT, et al. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65:i1–i58.

    PubMed  Google Scholar 

  28. Hill A, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax. 2019;74:1–69.

    PubMed  Google Scholar 

  29. • Judson M, Chaudhry H, Compa DR, O’Donnell AE. A Delphi study of pharmacotherpapy for noncystic fibrosis bronchiectasis. Am J Med Sci. 2014;348(5):387–93 This study attempts to assess the evidence of the therapies utilized for non-cystic fibrosis bronchiectasis.

    PubMed  Google Scholar 

  30. Bilton D, Henig N, Morrissey B, Gotfried M. Addition of inhaled tobramycin to ciprofloxacin for acute exacerbations of Pseudomonas aeruginosa infection in adult bronchiectasis. Chest. 2006;130:1503–10.

    PubMed  Google Scholar 

  31. Murray M, Turnbull K, MacQuarrie S, et al. Assessing response to treatment of exacerbations of bronchiectasis in adults. Eur Respir J. 2009;33:312–7.

    CAS  PubMed  Google Scholar 

  32. Friedman N, Temkin E, Carmeli Y. The negative impact of antibiotic resistance. Clin Microbiol Infect. 2016;22(5):416–22.

    CAS  PubMed  Google Scholar 

  33. Eliopoulous G, Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003;36(11):1433–7.

    Google Scholar 

  34. Thabit AK, Crandon JL, Nicolau DP. Antimicrobial resistance: impact on clinical and economic outcomes and the need for new antimicrobials. Expert Opin Pharmacother. 2015;16(2):159–77.

    PubMed  Google Scholar 

  35. Doern G, Brecher SM. The clinical predictive value (or lack thereof) of the results of In vitro antimicrobial susceptibility tests. J Clin Microbiol. 2011;49:S11–4.

    PubMed Central  Google Scholar 

  36. Somayaji R, Parkins MD, Shah A, et al. Antimicrobial resistance in cystic fibrosis international working group. Antimicrobial susceptibility testing (AST) and associated clinical outcomes in individuals with cystic fibrosis: a systematic review. J Cyst Fibros. 2019;18(2):236–43.

    CAS  PubMed  Google Scholar 

  37. Cogen J, Whitlock KB, Gibson RL, Hoffman LR, VanDevanter DR. The use of antimicrobial susceptibility testing in pediatric cystic fibrosis pulmonary exacerbations. J Cyst Fibros. 2019;(19):30764–7. https://doi.org/10.1016/j.jcf.2019.05.012.

    PubMed  Google Scholar 

  38. Murray M, Govan JRW, Doherty CJ, et al. A randomized controlled trial of nebulized gentamicin in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2011;183:491–9.

    CAS  PubMed  Google Scholar 

  39. Serisier D, Bilton D, De Soyza A, et al. Inhaled, dual release liposomal ciprofloxacin in non-cystic fibrosis bronchiectasis (ORBIT-2): a randomised, double-blind, placebo-controlled trial. Thorax. 2013;68:812–7.

    PubMed  PubMed Central  Google Scholar 

  40. Haworth C, Foweraker JE, Wilkinson P, et al. Inhaled colistin in patients with bronchiectasis and chronic Pseudomonas aeruginosa infection. Am J Respir Crit Care Med. 2014;189:975–82.

    PubMed  PubMed Central  Google Scholar 

  41. Currie D, Garbett ND, Chan KI, et al. Double-blind randomized study of prolonged higher-dose oral amoxycillin in purulent bronchiectasis. Q J Med. 1990;76:799–816.

    CAS  PubMed  Google Scholar 

  42. PROLONGED antibiotic treatement of severe bronchiectasis: a report by a subcommittee of the Antibiotics Clinical Trials (non-tuberculous) Committee of the Medical Research Council. Br Med J. 1957;2:255–259.

  43. • Hnin K, Nguyen C, Carson KV, et al. Prolonged antibiotics for non-cystic fibrosis bronchiectasis in children and adults. Cochrane Database Syst Rev. 2015;8:CD001392 This study assessess the current evidence for use of long-term antibiotics in non-cystic fibrosis bronchiectasis.

    Google Scholar 

  44. Gao Y, Guan W, Xu G, et al. Macrolide therapy in adults and children with non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis. PLoS One. 2014;9:e90047.

    PubMed  PubMed Central  Google Scholar 

  45. Brodt A, Stovold E, Zhang L. Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review. Eur Respir J. 2014;44:382–93.

    PubMed  Google Scholar 

  46. Shi Z, Peng H, Hu XW, Hu JG. Effectiveness and safety of macrolides in bronchiectasis patients: a meta-analysis and systematic review. Pulm Pharmacol Ther. 2014;28:171–8.

    CAS  PubMed  Google Scholar 

  47. Wong C, Jayaram I, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomized, double-blind, placebo-controlled trial. Lancet. 2012;380:660–7.

    CAS  PubMed  Google Scholar 

  48. Serisier D, Martin ML, McGuckin MA, et al. Effect of long-term, low-dose erythromycin on pulmonary exacerbations among patients with non-cystic fibrosis bronchiectasis: the BLESS randomized controlled trial. JAMA. 2013;309:1260–7.

    CAS  PubMed  Google Scholar 

  49. Altenburg J. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis. JAMA. 2013;309:1251–9.

    CAS  PubMed  Google Scholar 

  50. Nichols DP, Odem-Davis K, Cogen JD, et al. Pulmonary outcomes associated with long-term azithromycin therapy in cystic fibrosis. Am J Respir Crit Care Med 2019. https://doi.org/10.1164/rccm.201906-1206OC.

  51. West N, Beckett VV, Jain R, on behalf of the STOP investigators, et al. Standardized Treatment of Pulmonary Exacerbations (STOP) study: physician treatment practices and outcomes for individuals with cystic fibrosis with pulmonary exacerbations. J Cyst Fibros. 2017;16:600–6.

    PubMed  PubMed Central  Google Scholar 

  52. Sanders D, Solomon GM, Beckett VV, on behalf of the STOP Study Group, et al. Standardized Treatment of Pulmonary Exacerbations (STOP) Study: observations at the initiation of intravenous antibiotics for cystic fibrosis pulmonary exacerbations. J Cyst Fibros. 2017;16:592–9.

    PubMed  PubMed Central  Google Scholar 

  53. Ford I, Norrie J. Pragmatic trials. N Engl J Med. 2016;375:454–63.

    PubMed  Google Scholar 

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Funding

Dr. Goss’ research time is supported by the Cystic Fibrosis Foundation Therapeutics (GOSS13A0) and NIH (P30 DK089507, UL1TR000423). There was no role of funding sources in writing of this manuscript, or the decision to submit for publication.

Author information

Authors and Affiliations

  1. Department of Medicine and Microbiology, Immunology & Infectious Disease, University of Calgary, Calgary, Alberta, Canada

    R. Somayaji

  2. Department of Medicine and Pediatrics, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA

    C. H. Goss

  3. CFF Therapeutics Development Network Coordinating Center, Seattle Children’s Research Institute, Seattle, WA, USA

    C. H. Goss

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Contributions

All authors participated in drafting and/or revising the manuscript for intellectual content, and edited the manuscript for final approval.

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Correspondence to C. H. Goss.

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Conflict of Interest

Ranjani Somayaji declares no conflict of interest. Christopher Goss reports grants from Cystic Fibrosis Foundation, grants from European Commission, grants from NIH (NHLBI), grants from NIH (NIDDK and NCRR), personal fees from Gilead Sciences for serving as a Chair of a Grant Review Committee; personal fees from Novartis serving as a DSMB Chair for a trial supported by Novartis and the European Commission, grants from NIH, and grants from FDA for funding to study a novel antimicrobial in cystic fibrosis, and served a US lead in a phase 2 trial of novel therapy for cystic fibrosis support from Boehringer Ingelheim.

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None of the work presented in this opinion piece was influenced by the funding sources noted above. The funding sources that support other ongoing researches played no role in writing this manuscript, or in the decision to submit for publication.

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Somayaji, R., Goss, C.H. Duration of Antibiotic Therapy in Non-cystic Fibrosis Bronchiectasis. Curr Pulmonol Rep 8, 160–165 (2019). https://doi.org/10.1007/s13665-019-00235-w

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