Hurley MN, Prayle AP, Flume P. Intravenous antibiotics for pulmonary exacerbations in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD009730. DOI: 10.1002/14651858.CD009730.pub2.

Randomised controlled trials and the first treatment cycle of cross-over studies

Agostini 1983; Black 1990; Blumer 2005; Bosso 1988; Bosso 1989; BTS 1985; Caplan 1984; Church 1997; Conway 1985; Conway 1997; Cooper 1985; Costantini 1982; De Boeck 1989; De Boeck 1999; Elborn 1992; Gold 1985; Gold 1987; Hodson 1987; Huang 1983; Hyatt 1981; Knowles 1988; Macfarlane 1985; Master 2001; McCarty 1988; McLaughlin 1983; Padoan 1987; Penketh 1983; Penketh 1984; Regelmann 1990; Richard 1997; Salh 1992; Schaad 1986; Schaad 1987; Schaad 1989; Semykin 2010; Smith 1999; Stephens 1983; Wang 1988; Wesley 1988; Wientzen 1980

CF patients with cystic fibrosis of all ages and all degrees of disease severity, experiencing a pulmonary exacerbation

single intravenous antibiotic versus placebo; combination of intravenous antibiotics versus placebo; one regimen of intravenous antibiotics versus another intravenous regimen of antibiotics (with or without placebo); intravenous antibiotic regimen versus nebulised antibiotics; intravenous antibiotic regimen versus oral antibiotics

Primary outcomes: FEV1, FVC, time to next exacerbation, QoL

We included 40 studies involving 1717 participants. The quality of the included studies was largely poor and, with a few exceptions, these comprised of mainly small, inadequately reported studies.When comparing treatment with a single antibiotic to a combined antibiotic regimen, those participants receiving a combination of antibiotics experienced a greater improvement in lung function when considered as a whole group across a number of different measurements of lung function, but with very low quality evidence. When limited to the four placebo-controlled studies (n = 214), no difference was observed, again with very low quality evidence. With regard to the review's remaining primary outcomes, there was no effect upon time to next exacerbation and no studies in any comparison reported on quality of life. There were no effects on the secondary outcomes weight or adverse effects. When comparing specific antibiotic combinations there were no significant differences between groups on any measure. In the comparisons between intravenous and nebulised antibiotic or oral antibiotic (low quality evidence), there were no significant differences between groups on any measure. No studies in any comparison reported on quality of life.

The quality of evidence comparing intravenous antibiotics with placebo is poor. No specific antibiotic combination can be considered to be superior to any other, and neither is there evidence showing that the intravenous route is superior to the inhaled or oral routes. There remains a need to understand host-bacteria interactions and in particular to understand why many people fail to fully respond to treatment.