Efficacy And Safety Of Aerosolized Inhaled Antibacterials In The Adjuvant Treatment Of Respiratory Infection:A Meta-analysis

Objective In this study,a Meta-analysis was conducted to comprehensively analyze the published domestic and foreign studies on the administration of aerosol inhalation of antibacterial drugs in the treatment and adjuvant therapy of respiratory infectious diseases,in order to make a systematic evaluation on its effectiveness and safety.Methods Through the computer system to retrieve the study on the atomization inhalation of antibacterial drugs in the treatment of respiratory infectious diseases related literature: English literature in the Cochrane Library,Pub Med,Excerpta Medica Database,Web of Science Database retrieval,CNKI knowledge network in China,the Chinese literature of a Database of ten thousand,in CBMdisc network resources retrieval.To the date set for the self-built database retrieval time September31,2019,setting the type of randomized controlled trials,set the research object as the "people",which does not limit the language types,according to the standard screen into and expel the standard randomized controlled study,reference directory to the one by one into the literature by browsing consult,supplemented by manual retrieval methods to complement other documents in accordance with conditions.After reading the full text of the included literature,the baseline information,intervention measures,outcome indicators and outcome data of the patients included in the literature were extracted.According to Cochrane system evaluation member manual(version 5.1.0)[1]bias risk assessment tool to evaluate the methodological quality of included studies,the Cochrane collaboration system evaluation software Rev Man5.3 Meta analysis,the results of included studies used chi-square value calculated I2 to heterogeneity analysis included in the study,the P values obtained by software calculation and selection of I2 value research effect model,the obtained positive result further do sensitivity analysis of the stability of the evaluation results,do subgroup analysis explain the heterogeneity.Descriptive analysis was made for those studies with large heterogeneity and no data merger.Funnel plot was used to evaluate publication bias.Results A total of 61 studies covering 4273 patients were included.The results of Meta-analysis showed that in comparison with the control group without antibiotic atomization,atomization administration combined with routine treatment of respiratory diseases had a higher effective rate and significantly improved the patients’ clinical symptoms,with a statistically significant difference in the overall effective rate [RR=1.27,95%CI(1.22,1.33),P<0.00001].Aerosol inhalation of antimicrobial agents can reduce bacterial load and help bacteria turn negative[RR=1.33,95%CI(1.22,1.45),P<0.00001].Safety,compared with the control group atomization inhalation of antimicrobial agents for gastrointestinal reaction[RR=1.26,95% CI(0.99,1.62),P=0.06),liver function damage [RR=1.08,95% CI(0.76,1.52),P =0.67)and renal insufficiency(RR=0.83,95% CI(0.58,1.20),P=0.32]the incidence of adverse reactions such as not seen significant impact,but it can increase the risk of occurrence of bronchospasm lead to cough and gasp the[RR=2.17,95%CI(1.22,3.85),P=0.008].Compared with the control group,nebulized inhaled antimicrobial agents had a lower risk of developing new drug-resistant strains[RR=0.12,95%CI(0.28,0.86),P=0.01].It also showed a positive effect on reducing the acute exacerbation rate of the disease [RR=0.49,95%CI(0.36,1.06),P <0.00001].There was no significant difference in the impact on patient mortality[RR=1.02,95%CI(0.79,1.31),P=0.87].Conclusions Atomization inhalation of antimicrobial agents can be effective auxiliary treatment of respiratory infectious diseases,the existing evidence suggests that in the conventional treatment on the basis of the clinical effect of atomizing inhalation of antimicrobial agents and good bacteria turn rate is high.There is no significant effect on the incidence of adverse drug events such as gastrointestinal reaction,renal insufficiency and liver function injury,but it can increase the risk of inducing bronchospasm in patients,the risk is reasoned and will by improving the atomization dosage forms;There is not enough evidence to prove a significant effect on the mortality of patients.Limited by the quality of included studies and possible publication bias,the above conclusions need to be further clarified by more high-quality,large-sample randomized controlled studies.