Macrolides for diffuse panbronchiolitis
Ming Yang1, Bi Rong Dong, Jing Lu
1Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, China. yangmier@gmail.com
Background:
Diffuse panbronchiolitis (DPB) is a chronic airways disease predominantly affecting East Asians. Macrolides, a class of antibiotics, have been used as the main treatment for DPB, based on evidence from retrospective and non-randomised studies.
Objectives:
To assess the efficacy and safety of macrolides for DPB.
Search Methods:
We searched CENTRAL 2012, Issue 7, MEDLINE (1966 to July week 2, 2012), EMBASE (1974 to July 2012), Chinese Biomedical Literature Database (CBM) (1978 to July 2012), China National Knowledge Infrastructure (CNKI) (1974 to July 2012), KoreaMed (1997 to July 2012) and Database of Japana Centra Revuo Medicina (1983 to July 2012).
Selection Criteria:
Randomised controlled trials (RCTs) or quasi-RCTs assessing the effect of macrolides for DPB.
Data Collection And Analysis:
Two review authors independently assessed study quality and subsequent risk of bias according to the Cochrane Collaboration's tool for assessing risk of bias. The primary outcomes were five-year survival rate, lung function and clinical response. We used risk ratios (RR) for individual trial results in the data analysis and measured all outcomes with 95% confidence intervals (CI).
Main Results:
Only one RCT (19 participants) with significant methodological limitations was included in this review. It found that the computerised tomography images of all participants treated with a long-term, low-dose macrolide (erythromycin) improved from baseline, while the images of 71.4% of participants in the control group (with no treatment) worsened and 28.6% remained unchanged. Adverse effects were not reported.
Authors' Conclusions:
There is little evidence for macrolides in the treatment of DPB. We are therefore unable to make any new recommendations. It may be reasonable to use low-dose macrolides soon after diagnosis is made and to continue this treatment for at least six months, according to current guidelines.
Insights
Limited evidence supports macrolide antibiotics for diffuse panbronchiolitis (DPB). A single trial showed improvements in CT scans with erythromycin, but more research is needed to confirm macrolide efficacy for DPB.
Area of Science:
- Pulmonology
- Infectious Diseases
- Pharmacology
Background:
- Diffuse panbronchiolitis (DPB) is a chronic airway disease prevalent in East Asian populations.
- Macrolides are commonly prescribed for DPB, yet evidence primarily stems from non-randomized studies.
- The efficacy and safety of macrolides for DPB require rigorous evaluation.
Purpose of the Study:
- To systematically assess the efficacy and safety of macrolide antibiotics in treating diffuse panbronchiolitis (DPB).
- To synthesize evidence from randomized controlled trials (RCTs) and quasi-RCTs.
Main Methods:
- Searched multiple databases including MEDLINE, EMBASE, CENTRAL, CBM, CNKI, KoreaMed, and Japana Centra Revuo Medicina up to July 2012.
- Included randomized controlled trials (RCTs) or quasi-RCTs evaluating macrolides for DPB.
- Assessed study quality and risk of bias; analyzed outcomes like five-year survival, lung function, and clinical response using risk ratios and 95% confidence intervals.
Main Results:
- Only one RCT with 19 participants and methodological limitations was identified.
- All participants receiving long-term, low-dose erythromycin showed improved CT scan images.
- Control group participants experienced worsening or unchanged CT scan images; adverse effects were not reported.
Conclusions:
- Current evidence supporting macrolide use for DPB is minimal.
- The review cannot provide new treatment recommendations for DPB.
- Existing guidelines suggest low-dose macrolides for at least six months post-diagnosis may be reasonable.
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