Comparative efficacy and safety of inhaled antibiotics in managing chronic Pseudomonas aeruginosa infection in patients with cystic fibrosis and bronchiectasis: a systematic review and network meta-analysis.

Abstract

Background: An expanding array of inhaled antibiotic therapies can be effective for the treatment of chronic Pseudomonas aeruginosa (P. aeruginosa) infection in patients with cystic fibrosis (CF) and non-CF bronchiectasis (NCFB). Nonetheless, there is a paucity of direct studies comparing the curative effects of these regimens. This network meta-analysis (NMA) aimed to assess the efficacy and safety of different inhaled antibiotic therapies for the relative short-term (4 weeks) and long-term (≥4 months) management of chronic P. aeruginosa infection in patients with CF and NCFB, respectively.

Methods: We searched PubMed, Web of Science, Embase, and Cochrane Library database as at 25^th February, 2024. Randomized controlled trials (RCTs) involving inhaled antibiotic therapies for treatment of CF or NCFB were thoroughly screened. We conducted this NMA within a Bayesian framework. The surface under the cumulative ranking curve (SUCRA) was calculated to estimate relative effects of interventions per outcome.

Results: A total of 39 RCTs were included, involving 18 inhaled antibiotic treatment regimens and 7,486 participants. The primary outcomes assessed were microbiological efficacy and tolerability. According to SUCRA results, for patients with CF, tobramycin inhalation powder (TIP) had the best profile regarding microbiological efficacy at both short-term and long-term follow-up (SUCRA, 94.5%; 90.5%). Colistin for inhalation (SUCRA, 84.0%) and tobramycin inhalation solution (TIS; SUCRA, 75.7%) had the best tolerability profile at short-term and long-term follow-up, respectively. For patients with NCFB, TIP (SUCRA, 84.2%) and gentamicin injectable solution (GM) for inhalation (SUCRA, 92.2%) had the best profile regarding microbiological efficacy at short-term and long-term follow-up, respectively. Ciprofloxacin inhalation powder had the best tolerability profile at both short-term and long-term follow-up (SUCRA, 66.4%; 85.6%).

Conclusions: The present study suggests that inhalation of TIS and GM are deemed exhibiting favorable profile across various outcomes for treating chronic P. aeruginosa infection in patients with CF and NCFB, respectively. Further large-scale and higher-quality studies are needed to support the conclusion.