A Randomized Controlled Trial of Nebulized Gentamicin in Non–Cystic Fibrosis Bronchiectasis
Top Cited Papers
- 15 February 2011
- journal article
- research article
- Published by American Thoracic Society in American Journal of Respiratory and Critical Care Medicine
- Vol. 183 (4), 491-499
- https://doi.org/10.1164/rccm.201005-0756oc
Abstract
Bronchiectasis is a chronic debilitating disease with few evidence-based long-term treatments. A randomized controlled trial assessing the efficacy of nebulized gentamicin therapy over 1 year in patients with non-cystic fibrosis bronchiectasis. Sixty-five patients were randomized to either twice-daily nebulized gentamicin, 80 mg, or nebulized 0.9% saline, for 12 months. All were reviewed at three-monthly intervals during treatment and at 3 months' follow-up. At each review the following were assessed: quantitative and qualitative sputum bacteriology; sputum purulence and 24-hour volume; FEV(1), FVC, and forced expiratory flow, midexpiratory phase; exercise capacity; Leicester Cough Questionnaire and St. George's Respiratory Questionnaire; and exacerbation frequency. Fifty-seven patients completed the study. At the end of 12 months' treatment, compared with the saline group, in the gentamicin group there was reduced sputum bacterial density with 30.8% eradication in those infected with Pseudomonas aeruginosa and 92.8% eradication in those infected with other pathogens; less sputum purulence (8.7% vs. 38.5%; P < 0.0001); greater exercise capacity (510 [350-690] m vs. 415 [267.5-530] m; P = 0.03); and fewer exacerbations (0 [0-1] vs. 1.5 [1-2]; P < 0.0001) with increased time to first exacerbation (120 [87-161.5] d vs. 61.5 [20.7-122.7] d; P = 0.02). The gentamicin group had greater improvements in Leicester Cough Questionnaire (81.4% vs. 20%; P < 0.01) and St. George's Respiratory Questionnaire (87.5% vs. 19.2%; P < 0.004) score. No differences were seen in 24-hour sputum volume, FEV(1), FVC, or forced expiratory flow, midexpiratory phase. No P. aeruginosa isolates developed resistance to gentamicin. At follow-up, all outcome measures were similar to baseline. Regular, long-term nebulized gentamicin is of significant benefit in non-cystic fibrosis bronchiectasis but treatment needs to be continuous for its ongoing efficacy. Clinical trial registered with www.clinicaltrials.gov (NCT 00749866).Keywords
This publication has 40 references indexed in Scilit:
- Do processing time and storage of sputum influence quantitative bacteriology in bronchiectasis?Journal of Medical Microbiology, 2010
- Sputum colour: a useful clinical tool in non-cystic fibrosis bronchiectasisEuropean Respiratory Journal, 2009
- A randomised crossover trial of chest physiotherapy in non-cystic fibrosis bronchiectasisEuropean Respiratory Journal, 2009
- Validation of the Leicester Cough Questionnaire in non-cystic fibrosis bronchiectasisEuropean Respiratory Journal, 2009
- Variable antibiotic susceptibility in populations of Pseudomonas aeruginosa infecting patients with bronchiectasisJournal of Antimicrobial Chemotherapy, 2009
- Bronchiectasis in secondary care: a comprehensive profile of a neglected diseaseEuropean Journal of Internal Medicine, 2003
- Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factorsThorax, 2002
- Nebulisers for bronchiectasisThorax, 1997
- CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types.American Journal of Roentgenology, 1995
- Levels of neutrophil elastase and cathepsin B activities, and cystatins in human sputum: relationship to inflammationScandinavian Journal of Clinical and Laboratory Investigation, 1990