Long-term use of macrolides for bronchiectasis can reduce and delay exacerbations and improve quality of life even in patients currently excluded in guidelines, a meta-analysis shows.

Data for individual participants in three high-quality randomised controlled trials comparing at least three months of a macrolide use with placebo was reanalysed – effectively making a larger randomised controlled trial with 341 participants.

One of the studies included was the Australian BLESS trial of erythromycin vs placebo. The other two trials, including one from New Zealand, looked at azithromycin vs placebo.

The results showed that macrolides halved the rate of exacerbations and also increased the median time to first exacerbation from 90 days to 280 days, the Dutch-led researchers reported in the Lancet Respiratory Medicine.