According to bronchiectasis guidelines, patients with bronchiectasis and three more exacerbations per year should be prescribed to long-term macrolide treatment. The objective of this study is to evaluate the benefits of macrolide in subpopulations with bronchiectasis.

This systematic review and meta-analysis included 234 studies of macrolide antibiotics in adult patients with bronchiectasis. Data of 341 patients with a primary or secondary outcome of bronchiectasis exacerbations were extracted. The primary outcome of the study was the frequency of exacerbations requiring treatment with antibiotics. Secondary outcomes included time to first exacerbation and change in the quality of life according to the St George’s Respiratory Questionnaire (SGRQ) and change in FEV1.

The findings from the meta-analysis suggested that macrolide antibiotics reduced the frequency of exacerbations (adjusted incident rate ratio of 0.49). Macrolide treatment was also associated with an improved time to first exacerbation (hazard ratio 0.46) and quality of life (SGRQ mean improvement 2.93 points). However, the use of macrolides was not associated with a statistically significant improvement in FEV1. Subgroup analysis confirmed the efficacy of macrolides in reducing the frequency of exacerbations in all prespecified groups.

The research concluded that long-term macrolide treatment could reduce the frequency of exacerbations in patients with bronchiectasis.