Aztreonam lysine: a novel inhalational antibiotic for cystic fibrosis

Abstract

Acquisition of Pseudomonas aeruginosa, the most prevalent organism isolated from cystic fibrosis (CF) airways, is associated with an accelerated clinical deterioration and reduced survival. Strategies to chronically suppress P. aeruginosa infections in individuals with CF have evolved over the last four decades and now largely focus on regular administration of aerosolized antibiotics. Aztreonam lysine (AZLI; Cayston^®, Gilead Pharmaceuticals [Foster City, CA, USA]), a novel formulation of the monobactam aztreonam suitable for aerosol delivery has recently been developed. AZLI is administered as 75 mg three-times daily for 28 days in ‘on/off’ cycles using the Altera™/eFlow^® electronic nebulizer (PARI Innovative Manufacturers [Midlothian, VA, USA]). In individuals with CF chronically infected with P. aeruginosa, AZLI improved healthcare-associated quality-of-life scores, pulmonary function and weight, prolonged time to requirement of antibacterial therapy for symptoms of pulmonary exacerbation and reduced P. aeruginosa sputum burdens. These outcomes were durable over 18 months of cycled use. AZLI has been demonstrated to be safe and effective, and expands available chronic maintenance therapies in CF.

Keywords::

• aerosolized antibiotics
• aztreonam
• cystic fibrosis
• delivery system
• eFlow^®
• nebulized antibiotics
• Pseudomonas aeruginosa

Financial & competing interests disclosure

J Stuart Elborn has contributed to advisory boards for Gilead, Novartis and Bayer, and has received payment for this work. He is also co-investigator on two grant programs funded by Gilead through Queen’s University of Belfast. Michael D Parkins is supported by a clinical fellowship from the Canadian Cystic Fibrosis Foundation. 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.

No writing assistance was utilized in the production of this manuscript.