PP21 EFFICACY OF INHALED ANTIBIOTICS IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Sher Weyne Chee, Rafdzah Ahmad Zaki, Shih Ying Hng, Kah Peng Eg, Qiao Yun Lee, Jessie Anne de Bruyne, Anna Marie Nathan
University of Malaya, Kuala Lumpur, Malaysia.

Introduction:

The nebulization of antibiotics allows the delivery of high concentrations of medication to the lungs without the systemic side effects.

Objective:

To perform a systematic review and meta-analysis to determine the efficacy and safety of inhaled antibiotics in children with acute and chronic lung infections.

Methods:

We reviewed studies published in the last ten years that included children under 18 years old with acute or chronic lung infections treated with inhaled antibiotics. We collected clinical outcomes, bacterial clearance, and adverse effects. We excluded studies of children with cystic fibrosis and tracheostomy.

Results:

Seven articles were included: inhaled antibiotics in ventilator-associated pneumonia (VAP) [n=5] and non-cystic fibrosis bronchiectasis (NCFB) [n=2]. Meta-analysis revealed that in children with VAP, inhaled antibiotics + intravenous (IV) antibiotics resulted in a significant reduction in duration of mechanical ventilation (MD -4.14 days, 95% CI -5.10, -3.19; p<0.00001) and Intensive Care Unit (ICU) stay (MD -3.58 days, 95% CI -6.98, -0.18; p=0.04) and favourable odds of improved clinical success (RR 1.26, 95% CI 0.97, 1.64; p=0.08) and microbiological eradication (RR 1.28, 95% CI 0.96, 1.72, p=0.10). Inhaled + IV antibiotics were possibly associated with reduced nephrotoxicity (RR 0.27, 95% CI 0.05, 1.51; p=0.14) compared to IV antibiotics alone. Studies on inhaled antibiotics in children with NCFB both had small sample sizes but were associated with improved microbiological outcomes and some clinical outcomes.

Conclusion:

Adjunctive inhaled antibiotics to IV antibiotics are efficacious and safe in treating children with VAP. Available studies in children with NCFB showed promising results; however, further studies are required to ascertain this.