Nebulised antibiotics

Nebulised antibiotics

Jan, 2001. Nebulised antibiotics [online]. Seacroft and St James's University Hospitals, Leeds, UK. Available from http://www.cysticfibrosismedicine.com

The regular twice daily administration of a nebulised antibiotic has been an established treatment since Hodson published their paper in 1981 comparing nebulised gentamicin and carbenicillin with placebo in a double blind cross-over trial in 20 adult patients (Hodson, 1981). Subsequent studies have shown improved lung function, a slower decline in respiratory function, decreased hospital admission rates, better clinical scores, and better weight profile in patients who receive daily nebulised antibiotic treatment. In a meta-analysis, Mukhopadhyay, concluded that nebulised antibiotics significantly reduced the density of Pseudomonas aeruginosa in the lung and the frequency of respiratory exacerbations (Mukhopadhyay et al, 1996). This treatment should be considered for all patients chronically infected with Pseudomonas aeruginosa (Stead et al, 1987; Jensen et al, 1987; Smith et al, 1989; Ramsay, 1993) . Recent studies with a preservative free preparation of tobramycin for inhalation (Tobi) 300 mg twice a day, given on alternate months, showed a significant improvement in respiratory function and a significant fall in P. aeruginosa in the sputum. Hospital admissions and the need for intravenous antibiotic treatment also fell significantly (Ramsay et al, 1999). Two year data show that long term TOBI treatment is safe and maintains FEV1 at approximately 5% above baseline (Nickerson et all, 1999). This new preparation is now being assessed in European studies. Nebulised antibiotics are given after physiotherapy. It is particularity important that a suitable nebuliser and compressor are used (Littlewood et al, 1993). The combination of three weeks nebulised Colomycin and oral ciprofloxacin will significantly reduce the incidence of permanent P. aeruginosa infection in early colonised patients. Three months of treatment is likely to be even more effective (Valerius et al, 1991; Frederiksen et al, 1997).

For more details see CF (UK) Trust antibiotic consensus section

References

Frederiksen B, Koch C, Hoiby N. Antibiotic treatment at time of initial colonisation with Pseudomonas aeruginosa postpones chronic infection and prevents deterioration in pulmonary function in patients with cystic fibrosis. Pediatr Pulmonol 1997; 23: 330-335

Hodson ME, Penketh ARL, Batten JC. Aerosol carbenicillin and gentamicin treatment of Pseudomonas aeruginosa infection in patients with cystic fibrosis. Lancet 1981; ii: 1137-1139

Jensen T, Pedersen SS, Garne S, Heilman C, Hoiby N, Koch C. Colistin inhalation therapy in cystic fibrosis patients with chronic Pseudomonas aeruginosa infection. J Antimicrob Chemother 1987; 19: 831-838

Littlewood JM, Smye S W, Cunliffe H. Aerosol antibiotics in cystic fibrosis. Arch Dis Child 1993; 68: 788-792

Mukhopadhyay S, Singh M, Carter JI, Franklin M, Olver RE. Nebulised anti-pseudomonal antibiotic therapy in cystic fibrosis; a meta-analysis of benefits and risks. Thorax 1996; 51: 364-368.

Nickerson B, Montgomery AB, Kylstra JW, Ramsey BW. Safety and effectiveness of two years treatment with intermittent inhaled tobramycin in CF patients. Pediatr Pulmonol 1999; Suppl 19: 243

Ramsay BW, Dorkin HC, Eisenberg JD, Gibson RL, Harwood IR, Kravitz RM, et al. Efficacy of aerolised tobramycin in patients with cystic fibrosis. N Engl J Med 1993; 328: 1740-1746.

Smith AL, Ramsay BW, Hedges DL et al. Safety of aerosol tobramycin administration for three months to patients with cystic fibrosis. Pediatr Pulmonol 1989; 7: 265-271.

Stead JR, Hodson ME, Batten JC. Inhaled ceftazidime compared with gentamicin and carbenicillin in older patients with cystic fibrosis infected by Pseudomonas aeruginosa. Br J Dis Chest 1987; 81: 277-279

Valerius NH, Koch C, Hoiby N. Prevention of chronic Pseudomonas aeruginosa infection in cystic fibrosis by early treatment. Lancet 1991; 338: 725-726