Inhaled tobramycin in non-cystic fibrosis bronchiectasis: A meta-analysis of randomized controlled trials

Non-cystic fibrosis bronchiectasis (NCFB) is often complicated by chronic Pseudomonas aeruginosa infection. Inhaled antibiotics, such as tobramycin, have been explored for their efficacy in managing these infections, but their efficacy and safety in NCFB remains uncertain.

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the efficacy and safety of inhaled tobramycin in NCFB patients. PubMed, EMBASE, Cochrane Library, and ISI Web of Science databases were searched up to June 2024 using predefined keywords. Studies comparing inhaled tobramycin versus placebo were included if they reported outcomes related to P. aeruginosa eradication, sputum density, exacerbations, hospital admissions, and adverse events.

Nine RCTs involving 772 patients met the inclusion criteria. Inhaled tobramycin significantly increased P. aeruginosa eradication rates compared to placebo (I² = 22.0 %, P = 0.255; RR 2.422, 95 % CI 1.570 to 3.738, P < 0.001). There was a marked reduction in hospital admissions (I² = 27.9 %, P = 0.250; WMD -0.523, 95 % CI -0.879 to -0.167, P = 0.004) but no significant difference in exacerbation rates (I² = 31.9 %, P = 0.196; RR 0.837, 95 % CI 0.519 to 1.349, P = 0.464). Adverse events leading to trial discontinuation were higher in the tobramycin group (I² = 0.0 %, P = 0.634; RR 1.968, 95 % CI 1.197 to 3.236, P = 0.008).

Inhaled tobramycin therapy demonstrated efficacy in eradicating P. aeruginosa and reducing hospital admissions in patients with NCFB. However, no significant impact on exacerbation rates was observed, and the higher incidence of adverse events necessitates careful consideration in clinical practice.