This article is part of the Topical Collection on Bronchiectasis
Bronchiectasis is a debilitating chronic lung disease characterised by recurrent bacterial infection and colonisation with significant associated morbidity and mortality. To date, there are few licenced treatments, and the mainstay of clinical management is prompt antibiotic therapy for exacerbations and regular airway clearance. Inhaled antibiotics are a potential long-term treatment for those with recurrent exacerbations, and represent an obvious advantage over other routes of administration as they achieve high concentrations at the site of infection whilst minimising systemic side effects. The main caveat to such treatment is the development of antimicrobial resistance due to altered selection pressures.
Numerous studies of various inhaled antimicrobials have demonstrated favourable safety and efficacy profiles for bronchiectasis patients with chronic infection, which are supportive of their use in clinical practice.
There is no convincing evidence of treatment-emergent pathogens or pathogens developing resistance to the inhaled antibiotic therapy.
Laennec RTH, Forbes SJ. A treatise on the diseases of the chest, and on mediate auscultation. Samuel S. and William Wood; 1838. 848 p.
Quint JK, Millett ERC, Joshi M, Navaratnam V, Thomas SL, Hurst JR, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2015 Nov 5; ERJ-01033-2015.
Gao Y-H, Guan W-J, Liu S-X, Wang L, Cui J-J, Chen R-C, et al. Aetiology of bronchiectasis in adults: a systematic literature review. Respirol Carlton Vic. 2016;21(8):1376–83. CrossRef
• Hill AT, Bilton, Diana, Brown, Jerry, Burns, Graham, Calvert, James, Heslop, Karen, et al. British thoracic society quality standards for clinically significant bronchiectasis in adults. British Thoracic Society Reports, Vol 4, No 1; 2012. Consensus guidelines in the management of adult bronchiectasis, summarising the current evidence base and standard practice.
Cole PJ. Inflammation: a two-edged sword--the model of bronchiectasis. Eur J Respir Dis Suppl. 1986;147:6–15. PubMed
Angrill J, Agustí C, Celis R de, Rañó A, Gonzalez J, Solé T, et al. Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors. Thorax 2002 1;57(1):15–19.
Alanin MC, Nielsen KG, von Buchwald C, Skov M, Aanaes K, Høiby N, Johansen HK A longitudinal study of lung bacterial pathogens in patients with primary ciliary dyskinesia. Clin Microbiol Infect 2015;21(12):1093.e1–1091093.e7.
Hester KLM, Macfarlane JG, Tedd H, Jary H, McAlinden P, Rostron L, et al. Fatigue in bronchiectasis. QJM Int J Med. 2012;105(3):235–40. CrossRef
Ryan G, Singh M, Dwan K. Inhaled antibiotics for long-term therapy in cystic fibrosis. Cochrane Database Syst Rev. 2011;3:CD001021.
EUCAST. Clinical Breakpoints - bacteria (v 8.0) [Internet]. EUCAST; 2018 [cited 2018 May 2]. Available from: http://www.eucast.org/clinical_breakpoints/.
Weinstein, Melvin P. M100 Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. CLSI; 296 p.
Finch S, McDonnell MJ, Abo-Leyah H, Aliberti S, Chalmers JDA. Comprehensive analysis of the impact of Pseudomonas aeruginosa colonization on prognosis in adult bronchiectasis. Ann Am Thorac Soc. 2015;12(11):1602–11. PubMed
Metersky ML, Aksamit TR, Barker A, Choate R, Daley CL, Daniels LA, et al. The prevalence and significance of Staphylococcus aureus in patients with non-cystic fibrosis bronchiectasis. Ann Am Thorac Soc. 2018:18.
King PT, Sharma R. The lung immune response to nontypeable Haemophilus influenzae (lung immunity to NTHi) [Internet]. Journal of Immunology Research. 2015 [cited 2018 Feb 5]. Available from: https://www.hindawi.com/journals/jir/2015/706376/.
Scheinberg P, Shore E. A pilot study of the safety and efficacy of tobramycin solution for inhalation in patients with severe bronchiectasis. Chest. 2005;127(4):1420–6. PubMed
Orriols R, Hernando R, Ferrer A, Terradas S, Montoro B. Eradication therapy against Pseudomonas aeruginosa in non-cystic fibrosis bronchiectasis. Respir Int Rev Thorac Dis. 2015;90(4):299–305.
• De Soyza A, Aksamit T, Bandel T-J, Criollo M, Elborn JS, Operschall E, et al. RESPIRE 1: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis. Eur Respir J. 2018;51(1):1702052. Respire I & II are landmark multi-centre trials examining the role of inhaled dry-powder ciprofloxacin in the management of stable bronchiectasis. CrossRefPubMed
• Aksamit T, De Soyza A, Bandel T-J, Criollo M, Elborn JS, Operschall E, et al. RESPIRE 2: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis. Eur Respir J. 2018;51(1). Respire I & II are landmark multi-centre trials examining the role of inhaled dry-powder ciprofloxacin in the management of stable bronchiectasis.):1702053. CrossRefPubMed
Barker AF, O’Donnell AE, Flume P, Thompson PJ, Ruzi JD, de Gracia J, et al. Aztreonam for inhalation solution in patients with non-cystic fibrosis bronchiectasis (AIR-BX1 and AIR-BX2): two randomised double-blind, placebo-controlled phase 3 trials. Lancet Respir Med. 2014;2(9):738–49. CrossRefPubMed
Olveira C, Olveira G, Espildora F, Giron R-M, Muñoz G, Quittner AL, et al. Validation of a quality of life questionnaire for bronchiectasis: psychometric analyses of the Spanish QOL-B-V3.0. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2014;23(4):1279–92. CrossRef
- Risk of Development of Resistance in Patients with Non-Cystic Fibrosis Bronchiectasis Treated with Inhaled Antibiotics
Kate H. Regan
Adam T. Hill
- Springer US
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II