Oral versus inhaled antibiotics for people with bronchiectas | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Oral versus inhaled antibiotics for people with bronchiectasis

You can view up to 4 cases without signing up Sign up for unlimited access

Cochrane Review; no studies were identified for inclusion in the review.

Question

Are oral antibiotics (taken by mouth) or inhaled antibiotics more effective for reducing the duration and frequency of infective episodes of bronchiectasis, admissions to hospital and side effects, as well as reducing the risk of chest infections not responding to treatment with antibiotics?

Background

Bronchiectasis is a long-term incurable condition where people get repeated bacterial chest infections that lead to frequent cough, breathlessness and mucus production.

Antibiotics are commonly used to treat chest infections in people with bronchiectasis, to eliminate the specific types of bacteria that cause the infection. However it is currently unknown which method of administering antibiotics, orally or by inhalation, is most effective.

Study characteristics

While there have been a few studies investigating the benefits of antibiotics for people with bronchiectasis, none have compared orally administered antibiotics with inhaled antibiotics.

Quality of the evidence

There is no high-quality evidence available to determine whether oral or inhaled antibiotics are more helpful for people with bronchiectasis. More studies are needed.

Read the full Cochrane Review here

Comment

Sign up to add a comment

More about this case

ResolvedVerified literature

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ Bottom line\ Duloxetine and milnacipran may reduce pain in people with fibromyalgia. However, some of these people may also experience side effects, such as nausea and drowsiness. A minority of people with fibromyalgia experience symptom relief without side effects from duloxetine and milnacipran.\ Cochrane Review; 18 studies with 7903 participants. The studies were four to 27 weeks long and compared the SNRIs desvenlafaxine, duloxetine and milnacipran against placebo.\ Key results and quality of the evidence\ Duloxetine and milnacipran were better than placebo in reducing pain by 50% or more and in improving global well-being (low-quality evidence). Duloxetine and milnacipran were better than placebo in improving health-related quality of life and in reducing fatigue (low-quality evidence). Duloxetine and milnacipran were not better than placebo in reducing sleep problems (low-quality evidence). More people dropped out of the trial due to side effects with duloxetine and milnacipran than with placebo (low-quality evidence). More people reported nausea and drowsiness with duloxetine and milnacipran than with placebo (low-quality evidence). Duloxetine, milnacipran and placebo did not differ in the frequency of serious side effects experienced (very low-quality evidence).](https://app.figure1.com/case-detail/1863addd-f676-4911-8fb9-fe74196e7884)

\ \ Do antibiotics prevent surgical site infection after breast cancer surgery?\ What was the aim of this review?\ The aim of this review was to determine whether giving people antibiotics before or during an operation is effective for preventing surgical site infection (SSI) following breast cancer surgery. Researchers from Cochrane collected and analysed all relevant studies (randomised controlled trials) to answer this question and found 11 relevant studies. Randomised controlled trials are medical studies where people are chosen at random to receive different treatments. This type of trial provides the most reliable health evidence.\ Key messages\ There is moderate certainty evidence that antibiotics given before an operation probably reduce the risk of SSI in patients having surgery for breast cancer. We cannot be certain whether antibiotics given during an operation reduce the risk of developing an SSI, as the available evidence is of very low certainty.\ What was studied in this review?\ Breast cancer is the most common cancer affecting women and the leading cause of cancer death in women. Surgical removal of all or part of the breast is a common treatment for people diagnosed with breast cancer. However, an infection of the surgical wound is often a complication of the surgery, affecting up to 15% of patients. Having an SSI may require a longer stay in hospital or a repeat operation. Taking antibiotics prior to the operation or during the operation aims to reduce the risk of developing an infection in the surgical wound.\ What are the main results of the review?\ In August 2018 we searched for randomised controlled trials that investigated whether antibiotics given to people before or during surgery for breast cancer prevent an infection of the surgical site (SSI). This is an update of an existing review and no new relevant studies were found in the most recent search. We analysed the results of 11 studies with 2867 participants. Ten studies looked at giving antibiotics to patients prior to the surgery compared with not giving antibiotics or giving placebo. One study compared giving antibiotics perioperatively (between induction of anaesthetic and the patient leaving the recovery room) to not giving antibiotics. The results showed us that giving antibiotics before surgery probably reduced the risk of developing surgical site infection in patients undergoing breast cancer surgery with moderate certainty. No conclusions can be made from the results of the single study comparing perioperative antibiotics to no antibiotics as the evidence is of very low certainty. It is very uncertain whether there is an effect on incidence of adverse events. Furthermore, the effects on time to onset of infection, readmission to hospital and cost of care remain unclear. The review is not able to establish which antibiotic is most appropriate.\ How up to date is this review?\ We searched for studies that had been published up to August 2018.](https://app.figure1.com/case-detail/284c06c5-8441-4d3b-ac2a-d68120c2576b)

\ \ There is little evidence that antibiotics are effective for treating chronic rhinosinusitis. A three month course of antibiotics probably leads to a modest improvement in disease-specific quality of life in people without polyps, but the benefit doesn’t appear to last\ New Cochrane review; 5 studies, 293 people (adults and children, with and without nasal polyps), comparing oral antibiotics with intranasal or oral steroids](https://app.figure1.com/case-detail/72f7d0a8-bff4-426d-9eee-add4a1ea1366)

\ \ Review question\ We aimed to assess the existing evidence about the clinical benefits and harms of different antibiotics regimens used to treat people with infective endocarditis.\ Background\ Infective endocarditis is an infection of the inner lining of the heart. It is a serious infection that is frequently fatal, and cardiac surgery is often required. Antibiotics are medicines that treat infections and are the cornerstone of treatment for infective endocarditis. Treatment of patients with infective endocarditis is nosocomial (in‐hospital). Despite this, there are surprising differences between guidelines in their recommendations for antibiotic therapy. Furthermore, due to the dose and length of time that antibiotics must be given for, the antibiotics can have serious side effects, such as kidney and ear damage, and cause allergic reactions.\ Study characteristics\ We identified only six randomised controlled trials (studies in which participants are assigned to one of two or more treatment groups using a random method) that compared different antibiotic regimens, which included a limited number of participants. Each trial investigated different types and doses of antibiotics. The included studies were published between 1998 and 2019 and were conducted in the USA, Spain, Finland, and Denmark. The evidence is up‐to‐date as of 6 January 2020.\ Key results\ This first update confirms the findings of the original version of the review. Limited and low to very low‐quality evidence suggests that the comparative effects of different antibiotic regimens in terms of cure rates or other relevant clinical outcomes are uncertain. The conclusions of this updated Cochrane Review were based on few randomised controlled trials with a high risk of bias. Accordingly, the current evidence does not support or reject any regimen of antibiotic therapy for the treatment of infective endocarditis.\ Quality of evidence\ The confidence in the results of this review is low to very low. The included studies had limitations in the way they were designed and performed, and three studies were sponsored by the manufacturer of the medicine that was assessed. Moreover, the limited number of people included in the studies led to uncertain results. Larger studies are required to provide more information about the best antibiotic regimens to treat people with infective endocarditis.](https://app.figure1.com/case-detail/8d91aa84-5994-44e6-a7e3-fe24fecde3d5)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)