Administration of aerosolized antibiotics in cystic fibrosis patients

被引:57
作者
Moss, RB [1 ]
机构
[1] Stanford Univ, Med Ctr, Dept Pediat Pulm Med, Palo Alto, CA 94304 USA
关键词
aerosolized antibiotics; cystic fibrosis; Pseudomonas aeruginosa; tobramycin solution for inhalation;
D O I
10.1378/chest.120.3_suppl.107S
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
High rates of colonization and the challenge of managing Pseudomonas aeruginosa infections in patients with cystic fibrosis (CF) have necessitated a search for safe and effective antibiotics. Currently, therapy with an aminoglycoside in combination with a beta -lactam or a quinolone antibiotic is the standard. Unfortunately, it is difficult to deliver high doses of these antibiotics via the IV route without significant systemic adverse events (AEs) (eg, ototoxicity and nephrotoxicity). Recently, a reformulation of the aminoglycoside antibiotic tobramycin has become available in a preservative-free, pH-adjusted solution for inhalation by jet nebulizer. A 96-week series of clinical studies including 520 patients, aged greater than or equal to 6 years, with moderate-to-severe CF has evaluated the long-term safety and effectiveness of this formulation. Patients received tobramycin solution for inhalation (TSI) or placebo, which was administered in alternating cycles of 28-days-on and 28-days-off therapy, plus their usual CF care for 6 months with open-label follow-up extended to 2 years. Most AEs declined in frequency with increasing TSI exposure. Patients receiving TSI spent 25 to 33% fewer days in the hospital. Following the initiation of TSI treatment, patients experienced significant increases in FEV1. FEV1 values were maintained above baseline for the duration of the study series. Antibiotic susceptibility of the bacterial isolates did not predict clinical response. TSI was safe, well-tolerated, and effective for long-term treatment (96 weeks) of P aeruginosa colonization and infection in CF patients.
引用
收藏
页码:107S / 113S
页数:7
相关论文
共 13 条
[1]   CEFTAZIDIME IN CYSTIC-FIBROSIS - CLINICAL, MICROBIOLOGICAL AND IMMUNOLOGICAL STUDIES [J].
CULLEN, RT ;
MCCRAE, WM ;
GOVAN, J ;
RAEBURN, JA ;
INGRAM, TM .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 1983, 12 :369-375
[2]  
*CYST FIBR FDN, 1999, PAT REG 1998 ANN DAT
[3]  
*CYST FIBR FDN, 1998, PAT REG 1997 ANN DAT
[4]   Cystic fibrosis [J].
Davis, PB ;
Drumm, M ;
Konstan, MW .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1996, 154 (05) :1229-1256
[5]   Role of anti-pseudomonal antibiotics in the emergence of Stenotrophomonas maltophilia in cystic fibrosis patients [J].
Denton, M ;
Todd, NJ ;
Littlewood, JM .
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 1996, 15 (05) :402-405
[6]   A MULTICENTER STUDY OF ALTERNATE-DAY PREDNISONE THERAPY IN PATIENTS WITH CYSTIC-FIBROSIS [J].
EIGEN, H ;
ROSENSTEIN, BJ ;
FITZSIMMONS, S ;
SCHIDLOW, DV ;
BECKERMAN, R ;
CANNY, G ;
CAPLAN, D ;
FINK, R ;
GLASSER, L ;
HARLEY, F ;
HSU, J ;
LAPEY, A ;
LEWISTON, N ;
PALMER, J ;
LYRENE, R ;
BRASFIELD, D ;
NIELSON, D ;
PRESTIDGE, C .
JOURNAL OF PEDIATRICS, 1995, 126 (04) :515-523
[7]   MUCOID PSEUDOMONAS-AERUGINOSA IS A MARKER OF POOR SURVIVAL IN CYSTIC-FIBROSIS [J].
HENRY, RL ;
MELLIS, CM ;
PETROVIC, L .
PEDIATRIC PULMONOLOGY, 1992, 12 (03) :158-161
[8]   EFFECT OF HIGH-DOSE IBUPROFEN IN PATIENTS WITH CYSTIC-FIBROSIS [J].
KONSTAN, MW ;
BYARD, PJ ;
HOPPEL, CL ;
DAVIS, PB .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 332 (13) :848-854
[9]  
MENDELMAN PM, 1985, AM REV RESPIR DIS, V132, P761
[10]  
MOSS RB, IN PRESS CHEST