Macrolides for diffuse panbronchiolitis
Xiufang Lin1, Jing Lu, Ming Yang
1Center of Geriatrics and Gerontology, West China Hospital, Sichuan University, Chengdu, China.
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 (2014, Issue 6), MEDLINE (1966 to July week 1, 2014), EMBASE (1974 to July 2014), Chinese Biomedical Literature Database (CBM) (1978 to July 2014), China National Knowledge Infrastructure (CNKI) (1974 to July 2014), KoreaMed (1997 to July 2014) and Database of Japana Centra Revuo Medicina (1983 to July 2014).
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. This review was previously published in 2010 and 2013. For this 2014 update, we identified no new trials for inclusion or exclusion.
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). One small trial showed potential benefits, but more high-quality research is needed to confirm macrolide efficacy for DPB treatment.
Area of Science:
- Respiratory Medicine
- Pharmacology
Background:
- Diffuse panbronchiolitis (DPB) is a chronic airway disease prevalent in East Asian populations.
- Macrolide antibiotics are a primary treatment for DPB, supported by limited retrospective and non-randomized studies.
Purpose of the Study:
- To evaluate the efficacy and safety of macrolide antibiotics in treating diffuse panbronchiolitis (DPB).
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
- Searched multiple databases including CENTRAL, MEDLINE, EMBASE, CBM, CNKI, KoreaMed, and Japana Centra Revuo Medicina up to July 2014.
- Assessed study quality and risk of bias; primary outcomes included five-year survival, lung function, and clinical response.
Main Results:
- Included only one RCT with 19 participants and significant methodological limitations.
- The RCT indicated improvement in computerized tomography images for all participants receiving long-term, low-dose erythromycin compared to controls.
- No adverse effects were reported in the included trial; no new trials were identified for this 2014 update.
Conclusions:
- Current evidence for macrolide efficacy in DPB treatment is minimal.
- No new treatment recommendations can be made due to limited high-quality data.
- Current guidelines suggest low-dose macrolides for at least six months post-diagnosis may be reasonable.
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