Evaluation of the efficacy and safety of inhaled antibacterial therapy in bronchiectasis

Abstract

Bronchiectasis is a chronic respiratory disease characterized by structural changes of the bronchial tree, impaired mucociliary clearance, chronic bacterial infection, and recurrent exacerbations. Inhaled antibacterial therapy allows localized treatment of chronic infection in the airways. The aim was to evaluate the efficacy and safety of inhaled antibacterial therapy in bronchiectasis. Methods. An analytical review of the scientific literature on the efficacy and safety of inhaled antibacterial therapy in bronchiectasis was performed. Publications were searched in PubMed, Scopus, Web of Science, Cochrane Library, and eLibrary databases. Data on exacerbation frequency, time to first exacerbation, bacterial load, pathogen eradication, lung function parameters, quality of life, treatment tolerability, and adverse events were assessed. Results. Tobramycin has been shown to be associated with a reduction in bacterial load and an improvement in respiratory symptoms, with a safety profile comparable to placebo. The use of colistimethate sodium leads to a decrease in bacterial load. However, the evidence regarding its effect on exacerbation frequency remains inconsistent. Aztreonam has shown a predominantly selective effect on certain bronchitic symptoms, including cough, sputum characteristics and production, without comparable improvement in other respiratory manifestations. Inhaled ciprofloxacin is associated with a longer time to first exacerbation, a lower frequency of exacerbations, and a reduction in bacterial load. Conclusion. Inhaled tobramycin and ciprofloxacin therapy is associated with reduced bacterial load and exacerbation frequency in bronchiectasis. Clinical efficacy and tolerability differ across drugs and patient populations.