Background to the question

Bronchiectasis is a lung disease involving abnormal airways, leading to repeated chest infections, and associated with a mortality rate more than twice that of the general population. Although previously considered a relatively rare disease, numbers appear to be increasing, particularly for those over 75 years in low/middle-income countries. Antibiotics are the main therapy for chest infection, but their use must be weighed against potential side effects and the risk of increasing resistance to antibiotic therapy. One strategy to improve response and/or reduce antibiotic resistance involves giving two antibiotic agents at the same time: dual antibiotic therapy. This review therefore aimed to evaluate the effects of dual antibiotics for treatment of adults and children with bronchiectasis.

Study characteristics

In October 2017, we identified two relevant studies comparing oral plus inhaled dual therapy versus oral therapy alone. They included a total of 118 adults with an average age of 62.8 years. One study compared inhaled tobramycin plus oral ciprofloxacin with oral ciprofloxacin, and the second study compared inhaled gentamicin plus a systemic (affecting the whole body, rather than just the lungs) antibiotic with a systemic antibiotic alone. Only a research summary was available for the latter. Published papers did not report study funding sources

Main results

Results from one small trial of 53 adults show no evidence of treatment benefit with oral plus inhaled dual therapy in terms of successful treatment of exacerbations, the occurrence of serious unwanted events, amount of phlegm, lung function, or resistance to antibiotic treatment. However, we found insufficient evidence to permit confident conclusions about their use.

Quality of the evidence

The overall quality of the evidence was very poor, largely because one of the studies was not well described and included few participants. Information on exacerbations, exercise ability, and quality of life was not reported. We did not identify any trials that compared other types of dual antibiotic therapy, and we found none that included children. Therefore uncertainty remains concerning the use of dual antibiotics, and further high-quality studies are needed to examine the role of dual antibiotics in the treatment of adults and children with bronchiectasis.