Macrolide treatment in pediatric non-cystic fibrosis bronchiectasis: A meta-analysis

Rigman Darius Gabriel; Muhammad Asadullah Usman; Muhammad Aitzaz Akram; Allah Rakha Yaseen; Hamais Murtaza; Ishtiaq Ahmed

doi:10.5281/zenodo.13119903

Authors

Rigman Darius Gabriel
Muhammad Asadullah Usman University Institute of Biochemistry and Biotechnology, PMAS-Arid Agriculture University, Rawalpindi 46000, Pakistan https://orcid.org/0009-0006-1143-7568
Muhammad Aitzaz Akram University Institute of Biochemistry and Biotechnology, PMAS-Arid Agriculture University, Rawalpindi 46000, Pakistan https://orcid.org/0000-0003-4854-523X
Allah Rakha Yaseen School of Biological Sciences, Faculty of Life Sciences, University of the Punjab, Lahore, 54590, Pakistan https://orcid.org/0000-0001-7436-2926
Hamais Murtaza Sahiwal Teaching Hospital, Sahiwal, Pakistan. https://orcid.org/0009-0007-3445-0084
Ishtiaq Ahmed versity Institute of Biochemistry and Biotechnology, PMAS-Arid Agriculture University, Rawalpindi 46000, Pakistan and Metropole Laboratories (Private) Limited, Islamabad, Pakistan. https://orcid.org/0000-0002-1778-2286

DOI:

https://doi.org/10.5281/zenodo.13119903

Keywords:

Exacerbation frequency, long-term macrolide therapy, non-cystic fibrosis bronchiectasis, pediatric bronchiectasis

Abstract

Objective: This meta-analysis aims to systematically review and synthesize the available data on long-term macrolide treatment for NCFB in children.

Materials and methods: On December 2, 2023, we conducted a comprehensive search across multiple databases, including PubMed, Cochrane Library, Embase, Web of Sciences, and SCOPUS. There were no restrictions on language. The search terms used were "Macrolides," "Azithromycin," "Clarithromycin," "Roxithromycin," "Erythromycin," "Bronchiectasis," "Kartagener syndrome," and "Ciliary motility disorders." A total of 4 RCTs were included.

Results: A total of 92 patients in Macrolid group and 87 patients in control group were included in this meta analysis. Despite variations in macrolide preparations, long-term macrolide use significantly reduced the frequency of acute exacerbations in bronchiectasis (I²=0%) (OR: 0.30, 95% CI: 0.10 to 0.87; p=0.03). The findings showed that long-term macrolide treatment significantly reduced the mean exacerbations per patient (I²=84%; WMD -1.40, 95% CI: -2.26 to -0.54; p=0.001). The results indicated no significant difference in the frequency of exacerbation-related admissions between the azithromycin group and the control group (OR: 0.28, 95% CI: 0.07 to 1.11; p=0.07). The results showed no significant difference in FEV1 between the macrolide treatment group and the control group (I²=80%; WMD 2.21, 95% CI: -2.44 to 6.87; p=0.35). The results indicated no significant difference in the changes of FEV1% predicted before and after treatment between the macrolide group and the control group (I²=0%; WMD 2.19, 95% CI: -2.80 to 7.19; p=0.39).

Conclusions: This meta-analysis reveals that long-term macrolide treatment, spanning 3 to 24 months, significantly reduces the frequency of exacerbations in pediatric NCFB.

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