Impact of the use of macrolide antibiotics on bacterial resistance in non-fibrocystic bronchiectasis: a systematic review
DOI:
https://doi.org/10.17058/reci.v15i1.19905Abstract
Background and Objectives: bronchiectasis is a chronic respiratory disease characterized by irreversible bronchial wall dilation, mucociliary dysfunction, persistent cough, productive sputum and recurrent infections. The use of antibiotics is an essential part of the treatment of non-cystic fibrosis bronchiectasis, with macrolides being commonly used due to their anti-inflammatory properties and effectiveness in neutrophilic diseases. However, the frequent use of macrolides is concerning due to their potential to induce antimicrobial resistance. In this regard, this article assessed the impact of macrolide antibiotic therapy in non-cystic fibrosis bronchiectasis on the emergence of bacterial resistance. Methods: this is a descriptive systematic review, carried out in the PubMed, LILACS and SciELO databases, including all articles published until August 2020 that were available in Portuguese, English and/or Spanish, using the keywords “antimicrobial resistance” and “bronchiectasis”. On the other hand, reviews, opinion articles and editorials were excluded as well as those works that did not investigate bacterial resistance, especially to macrolide antibiotics. Results: the review found five studies, all carried out between 2008 and 2016 in Australia, New Zealand and the Netherlands, that assessed the effects of macrolides in children and adults with bronchiectasis. Four were controlled clinical trials and one was a prospective cohort study. Although studies have shown that macrolides were effective in reducing exacerbations and improving lung function, they have also reported the development of macrolide resistance in some cases. This article emphasizes the need for cautious use of macrolides in the treatment of bronchiectasis unrelated to cystic fibrosis due to the potential for antimicrobial resistance.
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