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  • Correspondence
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Correspondence on “Efficacy and safety of macrolides in the treatment of children with bronchiectasis: a meta-analysis”

Pediatric Research volume 95, page 593 (2024)Cite this article

Macrolide antibiotics are antimicrobial agents with anti-inflammatory and immunomodulatory properties, but their efficacy and safety in pediatric bronchiectasis remain highly controversial.1 Recently, Song et al. performed a meta-analysis based solely on data from randomized controlled trials, providing the highest quality medical evidence in the current literature.2 Contrary to previously published reviews and meta-analyses, the authors concluded that macrolides may not have sufficient efficacy and safety for the treatment of bronchiectasis in children.3,4,5 It should be recognized that this is a surprising study and provides strong evidence for clinicians in practice in the treatment of childhood bronchiectasis. However, we need to make some recommendations to further improve this study.

As an important reference for clinical decision making, meta-analyses should have a well-organized structure and precise statistical analysis. In our opinion, the authors should improve the following details: (1) the registration information of the studies should be detailed at the beginning of the Methods section to minimize possible selective bias; (2) the authors should emphasize in the search strategy whether there are any language limitations. If there are no limitations, many Chinese-language databases, such as China Knowledge Network, Wanfang, and VIP, should also be included in the search; (3) there is no assessment or description of publication bias in the text; (4) although the authors analyze a large number of outcome measures in the text, there is no assessment of the level of evidence for the outcomes. It should be recognized that readers will pay particular attention to the specific level of evidence when accessing information in the text to assess its credibility; (5) Although the authors performed reasonable sensitivity analyses, could appropriate subgroup analyses based on antibiotic dosage and duration of follow-up have been performed to further explain possible sources of heterogeneity? Overall, the quality of the study will be further improved if these shortcomings can be addressed.

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References

  1. Sun, J. & Li, Y. Long-term, low-dose macrolide antibiotic treatment in pediatric chronic airway diseases. Pediatr. Res. 91, 1036–1042 (2022).

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  1. Department of Neonatal and Pediatric Intensive Care, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, 445000, China

    Qifang Zheng

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  1. Qifang Zheng
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Correspondence to Qifang Zheng.

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Zheng, Q. Correspondence on “Efficacy and safety of macrolides in the treatment of children with bronchiectasis: a meta-analysis”. Pediatr Res 95, 593 (2024). https://doi.org/10.1038/s41390-023-02872-z

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