Efficacy and safety of ciprofloxacin for non-cystic fibrosis bronchiectasis: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Ying ^1,2,3 , SU Lin ^1,2 , LIU Shuang ^1,2 , WANG Yuting ^1,2 ,  DONG Birong ^1,2

1. The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
3. The First Hospital Affiliated to AMU, Chongqing, 400038, P.R.China;

Corresponding author：

DONG Birong, Email: birongdong@163.com

Keywords：

Non-cystic fibrosis bronchiectasis; Ciprofloxacin; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.201806093

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Objectives To systematically review the efficacy and safety of ciprofloxacin for non-cystic fibrosis bronchiectasis.Methods Databases including PubMed, EMbase, The Cochrane Library, CBM, VIP, CNKI and WanFang Data were electronically searched from inception to August 2018 to collect randomized controlled trials (RCTs) on ciprofloxacin in the treatment of non-cystic fibrosis bronchiectasis. Two reviewers independently screened literature, extracted data, and assessed risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 9 RCTs involving 1 666 patients were included. The results of meta-analysis showed that: compared with control group, the ciprofloxacin more efficiently eradicate bacteria from sputum (RR=4.34, 95%CI 2.04 to 9.23, P=0.000 1), decrease risk of the exacerbations (RR=0.81, 95%CI 0.71 to 0.93, P=0.002) and the mean bacterial load (MD=–4.08, 95%CI –6.29 to –1.87, P=0.001). However, there were no significant differences between two groups in clinical efficiency and adverse events.Conclusions The current evidence shows that, ciprofloxacin can decrease the mean bacterial load and risk of the exacerbation, and more efficiently eradicate bacteria from sputum in non-cystic fibrosis bronchiectasis patients. Due to limited quality and quantity of the included studies, more studies are required to verify the conclusions.

Citation： LIU Ying, SU Lin, LIU Shuang, WANG Yuting, DONG Birong. Efficacy and safety of ciprofloxacin for non-cystic fibrosis bronchiectasis: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(5): 557-564. doi: 10.7507/1672-2531.201806093 Copy

1.	Cole PJ. A new look at the pathogenesis and management of persistent bronchial sepsis: a "vicious circle" hypothesis and its logical therapeutic connotations. Oxford: Medicine Publishing Foundation, 1984.
2.	Brodt AM, Stovold E, Zhang L. Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review. Eur Respir J, 2014, 44(2): 382-393.
3.	Fjaellegaard K, Sin MD, Browatzki A, et al. Antibiotic therapy for stable non-CF bronchiectasis in adults-a systematic review. Chron Respir Dis, 2017, 14(2): 174-186.
4.	Justo JA, Danziger LH, Gotfried MH. Efficacy of inhaled ciprofloxacin in the management of non-cystic fibrosis bronchiectasis. Ther Adv Respir Dis, 2013, 7(5): 272-287.
5.	Cartlidge MK, Hill AT. Inhaled or nebulised ciprofloxacin for the maintenance treatment of bronchiectasis. Expert Opin Investig Drugs, 2017, 26(9): 1091-1097.
6.	Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Avariable at: http://www.handbook.cochrane.org/.
7.	陈素芹, 陈晨, 高海燕. 头孢哌酮/舒巴坦与环丙沙星治疗老年支气管扩张急性加重患者临床比较. 老年医学与保健, 2014, 20(6): 396-399.
8.	康建军, 高仑, 孙秀娥. 头孢哌酮舒巴坦钠与环丙沙星治疗老年支气管扩张急性加重患者临床效果比较. 临床医学研究与实践, 2017, 2(13): 31-32.
9.	Aksamit T, De Soyza A, Bandel TJ, et al. RESPIRE 2: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis. Eur Respir J, 2018, 51(1): 1702053.
10.	Bilton D, Henig N, Morrissey B, et al. Addition of inhaled tobramycin to ciprofloxacin for acute exacerbations of Pseudomonas aeruginosa infection in adult bronchiectasis. Chest, 2006, 130(5): 1503-1510.
11.	Chan TH, Ho SS, Lai CK, et al. Comparison of oral ciprofloxacin and amoxycillin in treating infective exacerbations of bronchiectasis in HongKong. Chemotherapy, 1996, 42(2): 150-156.
12.	Wilson R, Welte T, Polverino E, et al. Ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis: a phase II randomised study. Eur Respir J, 2013, 41(5): 1107-1115.
13.	Serisier DJ, Bilton D, De Soyza A, et al. Inhaled, dual release liposomal ciprofloxacin in non-cystic fibrosis bronchiectasis (ORBIT-2): a randomised, double-blind, placebo-controlled trial. Thorax, 2013, 68(9): 812-817.
14.	De Soyza A, Aksamit T, Bandel TJ, et al. Efficacy and tolerability of ciprofloxacin dry powder for inhalation (ciprofloxacin DPI) in bronchiectasis (non-CF etiology): results from the phase iii respire 1 study. Chest, 2016, 150(4): 1315A-1315A.
15.	De Soyza A, Aksamit T, Bandel TJ, et al. RESPIRE 1: Two phase III, randomized, multicentre, placebo-controlled trials of Ciprofloxacin dry powder for inhalation (Ciprofloxacin DPI) in non-cystic fibrosis bronchiectasis. Contemp Clin Trials, 2017, 58: 78-85.
16.	Rademacher J, Welte T. Bronchiectasis-diagnosis and treatment. Deutsches Ärzteblatt International, 2011, 108(48): 809.
17.	McDonnell, Melissa J, Hester, et al. Bronchiectasis: clinical features and management with a focus on inhaled antibiotics. Clin Pulm Med, 2014, 21(6): 251-261.
18.	Shi ZL, Peng H, Hu XW, et al. Effectiveness and safety of macrolides in bronchiectasis patients: a meta-analysis and systematic review. Pulm Pharmacol Ther, 2014, 28(2): 171-178.
19.	Wu Q, Shen W, Cheng H, et al. Long-term macrolides for non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis. Respirology, 2014, 19(3): 321-329.
20.	Rayner CF, Tillotson G, Cole PJ, et al. Efficacy and safety of long-term ciprofloxacin in the management of severe bronchiectasis. J Antimicrob Chemother, 1994, 34(1): 149-156.
21.	Cipolla D, Blanchard J, Gonda I. Development of liposomal ciprofloxacin to treat lung infections. Pharmaceutics, 2016, 8(1): e6.

1. Cole PJ. A new look at the pathogenesis and management of persistent bronchial sepsis: a "vicious circle" hypothesis and its logical therapeutic connotations. Oxford: Medicine Publishing Foundation, 1984.
2. Brodt AM, Stovold E, Zhang L. Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review. Eur Respir J, 2014, 44(2): 382-393.
3. Fjaellegaard K, Sin MD, Browatzki A, et al. Antibiotic therapy for stable non-CF bronchiectasis in adults-a systematic review. Chron Respir Dis, 2017, 14(2): 174-186.
4. Justo JA, Danziger LH, Gotfried MH. Efficacy of inhaled ciprofloxacin in the management of non-cystic fibrosis bronchiectasis. Ther Adv Respir Dis, 2013, 7(5): 272-287.
5. Cartlidge MK, Hill AT. Inhaled or nebulised ciprofloxacin for the maintenance treatment of bronchiectasis. Expert Opin Investig Drugs, 2017, 26(9): 1091-1097.
6. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions. Avariable at: http://www.handbook.cochrane.org/.
7. 陈素芹, 陈晨, 高海燕. 头孢哌酮/舒巴坦与环丙沙星治疗老年支气管扩张急性加重患者临床比较. 老年医学与保健, 2014, 20(6): 396-399.
8. 康建军, 高仑, 孙秀娥. 头孢哌酮舒巴坦钠与环丙沙星治疗老年支气管扩张急性加重患者临床效果比较. 临床医学研究与实践, 2017, 2(13): 31-32.
9. Aksamit T, De Soyza A, Bandel TJ, et al. RESPIRE 2: a phase III placebo-controlled randomised trial of ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis. Eur Respir J, 2018, 51(1): 1702053.
10. Bilton D, Henig N, Morrissey B, et al. Addition of inhaled tobramycin to ciprofloxacin for acute exacerbations of Pseudomonas aeruginosa infection in adult bronchiectasis. Chest, 2006, 130(5): 1503-1510.
11. Chan TH, Ho SS, Lai CK, et al. Comparison of oral ciprofloxacin and amoxycillin in treating infective exacerbations of bronchiectasis in HongKong. Chemotherapy, 1996, 42(2): 150-156.
12. Wilson R, Welte T, Polverino E, et al. Ciprofloxacin dry powder for inhalation in non-cystic fibrosis bronchiectasis: a phase II randomised study. Eur Respir J, 2013, 41(5): 1107-1115.
13. Serisier DJ, Bilton D, De Soyza A, et al. Inhaled, dual release liposomal ciprofloxacin in non-cystic fibrosis bronchiectasis (ORBIT-2): a randomised, double-blind, placebo-controlled trial. Thorax, 2013, 68(9): 812-817.
14. De Soyza A, Aksamit T, Bandel TJ, et al. Efficacy and tolerability of ciprofloxacin dry powder for inhalation (ciprofloxacin DPI) in bronchiectasis (non-CF etiology): results from the phase iii respire 1 study. Chest, 2016, 150(4): 1315A-1315A.
15. De Soyza A, Aksamit T, Bandel TJ, et al. RESPIRE 1: Two phase III, randomized, multicentre, placebo-controlled trials of Ciprofloxacin dry powder for inhalation (Ciprofloxacin DPI) in non-cystic fibrosis bronchiectasis. Contemp Clin Trials, 2017, 58: 78-85.
16. Rademacher J, Welte T. Bronchiectasis-diagnosis and treatment. Deutsches Ärzteblatt International, 2011, 108(48): 809.
17. McDonnell, Melissa J, Hester, et al. Bronchiectasis: clinical features and management with a focus on inhaled antibiotics. Clin Pulm Med, 2014, 21(6): 251-261.
18. Shi ZL, Peng H, Hu XW, et al. Effectiveness and safety of macrolides in bronchiectasis patients: a meta-analysis and systematic review. Pulm Pharmacol Ther, 2014, 28(2): 171-178.
19. Wu Q, Shen W, Cheng H, et al. Long-term macrolides for non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis. Respirology, 2014, 19(3): 321-329.
20. Rayner CF, Tillotson G, Cole PJ, et al. Efficacy and safety of long-term ciprofloxacin in the management of severe bronchiectasis. J Antimicrob Chemother, 1994, 34(1): 149-156.
21. Cipolla D, Blanchard J, Gonda I. Development of liposomal ciprofloxacin to treat lung infections. Pharmaceutics, 2016, 8(1): e6.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of ciprofloxacin for non-cystic fibrosis bronchiectasis: a meta-analysis

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