John: The Cochrane Airways group has now produced more than 300 full reviews, across a wide range of lung problems. One of these is bronchiectasis and an updated review from August 2015 examines the effects of long-term antibiotic therapy. Khin Hnin, from Flinders University in Adelaide Australia, summarizes the findings in this evidence pod.

Khin: Bronchiectasis is a common chronic respiratory condition. The lungs of patients with bronchiectasis have excessive secretions, which tend to contain various types of micro-organisms. Long-term antibiotic therapy has been proposed as one way to reduce the damage to the lungs caused by exacerbations when the patient’s bronchiectasis worsens. By systematically reviewing the available literature, we have found that this is generally effective but there are also some reasons for concern about widespread use of the therapy.
We found 18 studies including more than 1,000 participants. Each study compared at least four weeks of antibiotic therapy with usual care and or placebo. Twelve of these randomized trials used an oral antibiotic such as azithromycin or ciprofloxacin; while the other six tested inhaled medications such as Tobramycin, Gentamicin and Ceftazidime.
By doing this update for the Cochrane Review, which was previously published in April 2007, we have been able to provide a stronger evidence base on the benefits of prolonged antibiotic use in patients with bronchiectasis. The drugs at least halved the odds of exacerbation and were well tolerated. However, we also found a clear risk of emerging drug resistance, which is of concern at the level of individuals, as well as for communities. Therefore, we conclude that long term antibiotic use is a well tolerated and effective therapy however, careful patient selection is extremely important.

John: If you’d like to read more about the accumulating evidence in this area, just visit Cochrane Library dot com and search 'bronchiectasis and antibiotic'.