A Randomized Controlled Trial of Nebulized Gentamicin in Non–Cystic Fibrosis Bronchiectasis

Maeve P Murray, John R W Govan, Catherine J Doherty, A John Simpson, Thomas S Wilkinson, James D Chalmers, Andrew P Greening, Christopher Haslett, Adam T Hill

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Rationale: Bronchiectasis is a chronic debilitating disease with few evidence-based long-term treatments.

Objectives: A randomized controlled trial assessing the efficacy of nebulized gentamicin therapy over 1 year in patients with non–cystic fibrosis bronchiectasis.

Methods: 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.

Measurements and Main Results: At each review the following were assessed: quantitative and qualitative sputum bacteriology; sputum purulence and 24-hour volume; FEV1, 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, FEV1, 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.

Conclusions: 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).
Original languageEnglish
Pages (from-to)491-499
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume183
Issue number4
DOIs
Publication statusPublished - 15 Feb 2011

Keywords / Materials (for Non-textual outputs)

  • bronchiectasis
  • nebulized anibiotics
  • gentamicin

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