The clinical effect of antibiotic eradication or suppression treatment in patients with non-CF bronchiectasis who are colonized with Pseudomonas aeruginosa

Abstract The clinical benefit of Pseudomonas aeruginosa ( P. aeruginosa ) eradication or suppression is well established in patients with Cystic Fibrosis who are colonized with P aeruginosa . However, for patients with non-Cystic Fibrosis bronchiectasis, it remains unclear. The objective of this systematic review (PROSPERO registration number: CRD42023434134 ) is to investigate the clinical effects of antibiotic eradication or suppression treatment in patients with non-CF bronchiectasis who are colonized, or by some professionals referred to as chronically infected, with P. aeruginosa on sputum culture positivity, exacerbations, hospitalization, lung function, and quality of life, compared to non-treated patients. The Ovid MEDLINE and EMBASE databases were used to identify 7 relevant articles for this review. In these articles, different P. Aeruginosa eradication or suppression schemes, which consist of inhaled antibiotic treatments, were used. None of these studies demonstrated an effect on the sputum density of P. aeruginosa during the follow-up period. Two studies showed a significant effect of nebulized gentamicin and dual-release ciprofloxacin for inhalation on the number of exacerbations. Only one study demonstrated significantly fewer admissions and days of admission in the aerosolised tobramycin group compared with placebo. None of the studies demonstrated an effect on lung function and all studies showed a varying effect on quality of life. Evidence on the clinical effects of P. aeruginosa eradication/suppression treatment in non-CF patients with bronchiectasis who are colonized with P. aeruginosa is limited. Eradication or suppression does not affect the sputum bacterial density and lung function during follow-up. At most, only minimal effects are to be expected on the number of exacerbations, hospitalizations, and quality of life.