The use of tobramycin for Pseudomonas aeruginosa: a review

ABSTRACT

Introduction

Pseudomonas aeruginosa is a common respiratory pathogen that contributes to chronic pulmonary infection in individuals with cystic fibrosis. Guidelines recommend early intervention upon positive P. aeruginosa culture. Tobramycin has in vitro activity against Gram-negative bacteria, including P. aeruginosa, and TOBI Podhaler is indicated for the management of individuals with cystic fibrosis with P. aeruginosa infection. The dry powder inhaler formulation decreases the time required for treatment compared with nebulized solution and therefore may improve quality of life and adherence, which have a positive impact on disease progression.

Areas covered

In this review, we discuss the safety and efficacy of tobramycin inhaled powder and provide insights into appropriate individuals who might benefit from a dry powder inhaler, keeping in mind that patient preference is an important consideration for therapy selection.

Expert opinion

Providing a less burdensome alternative to delivering inhaled antibiotics that is more portable with a significantly shorter administration time may help improve adherence, and therefore improve outcomes. Continued development of new antibiotics to add to current regimens for eradication and control of airway microbiology, combined with more efficient delivery systems such as tobramycin inhaled powder, will help evolve the treatment of patients with CF.

KEYWORDS:

• (4-10): cystic fibrosis
• Pseudomonas aeruginosa
• dry powder inhaler
• tobramycin
• antibiotic use
• adherence

Article highlights

• Tobramycin has in vitro activity against Gram-negative bacteria, including P. aeruginosa, and TOBI Podhaler is indicated for the management of individuals with cystic fibrosis with P. aeruginosa infection.

• Results from studies have demonstrated that tobramycin inhalation solution (TIS) and powder (TIP) are effective and well tolerated.

• TIP has been shown to improve FEV₁ by ~6%, to reduce respiratory-related hospitalizations, and to reduce the proportion of individuals requiring antibiotic use and the duration of antibiotic use required.

• TIP has been associated with improved tolerability, adherence, and patient satisfaction.

• By reducing the administration time and being more convenient (portable), the use of TIP may have beneficial effects on adherence and clinical outcomes.

Acknowledgments

The authors would like to thank Stephanie A. Breslan, MS and Strategix for their writing and editorial assistance.

Declaration of interest

S. Fiel has received financial grants from Vertex, Laurent, Cystic Fibrosis Foundation and has worked as a paid consultant/paid speaker for Gilead; E. Roesch has received financial grants from several industry sponsored clinical trials. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

Technical, editorial and medical writing assistance were provided under the direction of the authors by Strategix, and affiliate of the Lynx Group, LLC. Funding for this support was provided by Vitaris Inc. Vitaris Inc. had no role in the technical, editorial or medical writing of this manuscript.