Inhaled antibiotics for the treatment of chronic bronchopulmonary Pseudomonas aeruginosa infection in cystic fibrosis: systematic review of randomised controlled trials

Abstract

Introduction: Inhaled antibiotics are probably the safest and most effective therapy for Pseudomonas aeruginosa chronic lung infection in cystic fibrosis (CF) patients.

Areas covered: To summarise the available evidence, a systematic review of the three currently available inhaled antibiotics (aztreonam lysine (AZLI), colistin (COL) and tobramycin (TOB)) was performed. The three AZLI placebo-controlled studies showed that the improvements in FEV₁ and mean sputum P. aeruginosa density were statistically significant better than with placebo. The two COL placebo-controlled studies involved few patients but showed that COL was better than placebo in terms of maintenance of some pulmonary function parameters. The tobramycin inhalation solution (TIS) and tobramycin inhalation powder studies showed that the efficacy of both formulations was similar but significantly better than placebo. In the comparative studies, TIS showed more efficacy than COL solution, colistin inhalation powder showed non-inferiority to TIS and AZLI was superior to TIS.

Expert opinion: Placebo-controlled and comparative clinical trials have shown that clinical evidence of inhaled antibiotics is very different. The choice of treatment for each individual CF patient must be based on the features of the drug (clinical evidence on efficacy and safety), the inhalation system and the patient characteristics. Development of new inhaled antibiotics will allow new end points of efficacy and therapy regimens to be assessed.

Keywords::

• aztreonam lysine
• colistin
• cystic fibrosis
• inhaled antibiotics
• Pseudomonas aeruginosa
• tobramycin

Declaration of interest

L Máiz has served as a consultant and/or for membership on advisory boards for Gilead, Novartis and Praxis. RM Girón has participated in educational programs funded by Gilead, Novartis and Praxis, and currently has a research grant from Gilead. C Olveira has participated in educational programs funded by Gilead, Novartis and Praxis. E Quintana has served as a consultant and/or for membership on advisory boards for Gilead, Novartis and Praxis. This study was funded with a grant from Gilead Spain. Content Ed Net provided medical writing assistance, funded by Gilead Spain.

Notes

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