Tags

Type your tag names separated by a space and hit enter

Effectiveness and safety of macrolides in cystic fibrosis patients: a meta-analysis and systematic review.
J Antimicrob Chemother. 2011 May; 66(5):968-78.JA

Abstract

OBJECTIVES

To evaluate the efficacy and safety of macrolides in cystic fibrosis (CF).

METHODS

Randomized controlled trials (RCTs) of macrolides for the treatment of CF published in PubMed, the Cochrane Library and Embase were searched. Application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality were independently performed in duplicate. The primary efficacy outcome was the impact on the deterioration of lung function (changes in FEV(1) and FVC). Safety outcomes included adverse events and mortality.

RESULTS

Eight RCTs (seven with azithromycin and one with clarithromycin) were found in the systematic review and six RCTs with azithromycin (654 patients) were included in the meta-analysis. Azithromycin treatment showed a significant increase in FEV(1)% (3.22%, 95% CI = 1.38-5.06, P = 0.0006, I(2) = 0%) and FVC% (3.23%, 95% CI = 1.62-4.85, P < 0.0001, I(2) = 0%) compared with placebo. In individuals with baseline Pseudomonas aeruginosa colonization, both FEV(1)% (4.80%, 95% CI = 1.66-7.94, P = 0.003, I(2) = 42%) and FVC% (4.74%, 95% CI = 1.92-7.57, P = 0.001, I(2) = 0%) increased significantly. The incidence rates of the main side effects (cough, headache, abdominal pain, vomiting, nausea and diarrhoea) were not significantly different between the azithromycin-treated group and the placebo group. The RCT of clarithromycin, involving 18 patients, showed its effects on clinical improvement; however, the small sample size made comparisons with azithromycin difficult.

CONCLUSIONS

Long-term use of azithromycin can improve lung function, especially for P. aeruginosa-colonized CF patients. There was no evidence of increased adverse events with azithromycin. More data are needed to verify the best azithromycin regimen and to evaluate other macrolides in CF patients.

Authors+Show Affiliations

Department of Clinical Pharmacology, PLA General Hospital, Beijing, People's Republic of China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

21393178

Citation

Cai, Yun, et al. "Effectiveness and Safety of Macrolides in Cystic Fibrosis Patients: a Meta-analysis and Systematic Review." The Journal of Antimicrobial Chemotherapy, vol. 66, no. 5, 2011, pp. 968-78.
Cai Y, Chai D, Wang R, et al. Effectiveness and safety of macrolides in cystic fibrosis patients: a meta-analysis and systematic review. J Antimicrob Chemother. 2011;66(5):968-78.
Cai, Y., Chai, D., Wang, R., Bai, N., Liang, B. B., & Liu, Y. (2011). Effectiveness and safety of macrolides in cystic fibrosis patients: a meta-analysis and systematic review. The Journal of Antimicrobial Chemotherapy, 66(5), 968-78. https://doi.org/10.1093/jac/dkr040
Cai Y, et al. Effectiveness and Safety of Macrolides in Cystic Fibrosis Patients: a Meta-analysis and Systematic Review. J Antimicrob Chemother. 2011;66(5):968-78. PubMed PMID: 21393178.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness and safety of macrolides in cystic fibrosis patients: a meta-analysis and systematic review. AU - Cai,Yun, AU - Chai,Dong, AU - Wang,Rui, AU - Bai,Nan, AU - Liang,Bei-Bei, AU - Liu,Youning, Y1 - 2011/03/02/ PY - 2011/3/12/entrez PY - 2011/3/12/pubmed PY - 2011/7/19/medline SP - 968 EP - 78 JF - The Journal of antimicrobial chemotherapy JO - J Antimicrob Chemother VL - 66 IS - 5 N2 - OBJECTIVES: To evaluate the efficacy and safety of macrolides in cystic fibrosis (CF). METHODS: Randomized controlled trials (RCTs) of macrolides for the treatment of CF published in PubMed, the Cochrane Library and Embase were searched. Application of inclusion and exclusion criteria, data extraction, and assessment of methodological quality were independently performed in duplicate. The primary efficacy outcome was the impact on the deterioration of lung function (changes in FEV(1) and FVC). Safety outcomes included adverse events and mortality. RESULTS: Eight RCTs (seven with azithromycin and one with clarithromycin) were found in the systematic review and six RCTs with azithromycin (654 patients) were included in the meta-analysis. Azithromycin treatment showed a significant increase in FEV(1)% (3.22%, 95% CI = 1.38-5.06, P = 0.0006, I(2) = 0%) and FVC% (3.23%, 95% CI = 1.62-4.85, P < 0.0001, I(2) = 0%) compared with placebo. In individuals with baseline Pseudomonas aeruginosa colonization, both FEV(1)% (4.80%, 95% CI = 1.66-7.94, P = 0.003, I(2) = 42%) and FVC% (4.74%, 95% CI = 1.92-7.57, P = 0.001, I(2) = 0%) increased significantly. The incidence rates of the main side effects (cough, headache, abdominal pain, vomiting, nausea and diarrhoea) were not significantly different between the azithromycin-treated group and the placebo group. The RCT of clarithromycin, involving 18 patients, showed its effects on clinical improvement; however, the small sample size made comparisons with azithromycin difficult. CONCLUSIONS: Long-term use of azithromycin can improve lung function, especially for P. aeruginosa-colonized CF patients. There was no evidence of increased adverse events with azithromycin. More data are needed to verify the best azithromycin regimen and to evaluate other macrolides in CF patients. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/21393178/Effectiveness_and_safety_of_macrolides_in_cystic_fibrosis_patients:_a_meta_analysis_and_systematic_review_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkr040 DB - PRIME DP - Unbound Medicine ER -