This systematic review and meta-analysis evaluates the efficacy and safety of inhaled antibiotics in treating bronchiectasis in adults. The study included 20 randomized controlled trials involving 3,468 patients. Key findings include: - **Efficacy**: Inhaled antibiotics significantly reduced the number of patients experiencing exacerbations (risk ratio [RR], 0.85; 95% CI, 0.75-0.96), exacerbation frequency (RR, 0.78; 95% CI, 0.68-0.91), severe exacerbations (RR, 0.48; 95% CI, 0.31-0.74), and prolonged time to the first exacerbation (hazard ratio, 0.80; 95% CI, 0.68-0.94). - **Safety**: Adverse events were not significantly increased, with a pooled odds ratio (OR) of 0.99 (95% CI, 0.75-1.30). However, antibiotic-resistant organisms were more likely to be isolated (OR, 1.86; 95% CI, 1.51-2.30). - **Quality of Life and Symptoms**: Inhaled antibiotics improved respiratory symptoms and quality of life, with significant improvements in the Quality of Life Questionnaire-Bronchiectasis (mean difference, 2.51; 95% CI, 0.44-4.31) and the St. George Respiratory Questionnaire (mean difference, −3.13; 95% CI, −5.93 to −0.32). The analysis suggests that inhaled antibiotics are effective in reducing exacerbations and improving symptoms and quality of life in adults with bronchiectasis, with a generally favorable safety profile.This systematic review and meta-analysis evaluates the efficacy and safety of inhaled antibiotics in treating bronchiectasis in adults. The study included 20 randomized controlled trials involving 3,468 patients. Key findings include: - **Efficacy**: Inhaled antibiotics significantly reduced the number of patients experiencing exacerbations (risk ratio [RR], 0.85; 95% CI, 0.75-0.96), exacerbation frequency (RR, 0.78; 95% CI, 0.68-0.91), severe exacerbations (RR, 0.48; 95% CI, 0.31-0.74), and prolonged time to the first exacerbation (hazard ratio, 0.80; 95% CI, 0.68-0.94). - **Safety**: Adverse events were not significantly increased, with a pooled odds ratio (OR) of 0.99 (95% CI, 0.75-1.30). However, antibiotic-resistant organisms were more likely to be isolated (OR, 1.86; 95% CI, 1.51-2.30). - **Quality of Life and Symptoms**: Inhaled antibiotics improved respiratory symptoms and quality of life, with significant improvements in the Quality of Life Questionnaire-Bronchiectasis (mean difference, 2.51; 95% CI, 0.44-4.31) and the St. George Respiratory Questionnaire (mean difference, −3.13; 95% CI, −5.93 to −0.32). The analysis suggests that inhaled antibiotics are effective in reducing exacerbations and improving symptoms and quality of life in adults with bronchiectasis, with a generally favorable safety profile.