Aerosol antibiotic treatment in cystic fibrosis.

Littlewood, J M; Smye, S W; Cunliffe, Helen

doi:10.1136/adc.68.6.788

Cited by 31 publications

(17 citation statements)

References 40 publications

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“…As no approved formulations for inhalation were available, drugs were composed from intravenous formulations containing preservatives, with doses selected not by preclinical safety or efficacy testing, but based on how parenteral formulations were composed [75]. Different studies demonstrated airway narrowing and chest tightness after inhalation of these nebulized antibiotics [33,97,98]. In Europe, nebulized tobramycin and colistin are used after initial isolation of Pa, to treat acute infection and to delay and/or treat chronic infection [44,97,[99][100][101].…”

Section: Bhr and Nebulized Antibioticsmentioning

confidence: 99%

“…Since the early 1980s, several trials have studied inhaled antibiotics as a suppressive treatment of chronic Pa infection in CF [10,[31][32][33][34][35]. As no approved formulations for inhalation were available, drugs were composed from intravenous formulations containing preservatives, with doses selected not by preclinical safety or efficacy testing, but based on how parenteral formulations were composed [75].…”

Section: Bhr and Nebulized Antibioticsmentioning

confidence: 99%

“…the active molecule and chemical additives [32]. The osmolality of the solution appears to be an important factor in how the nebulization is tolerated by the patient [9,33,34]. Both hypo-and hypertonic solutions may result in mucosal irritation [9][10][11]32,33].…”

Section: Mechanisms Of Bhrmentioning

confidence: 99%

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Bronchial Hyperreactivity Related to Inhalation Therapy in Cystic Fibrosis Patients

Eyns¹

2014

J Pulm Respir Med

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It is presumed that bronchial hyperreactivity (BHR) can occur with any inhaled agent and may be a reason for discontinuation of inhalation therapy in cystic fibrosis (CF) patients. On the other hand, inhalation of antibiotics is being increasingly used to eradicate or treat infections.This review focuses on identifying the mechanisms of BHR for a better understanding of its impact on inhalation treatment. BHR in CF is suggested to be secondary to underlying airway disease (associated to poor pulmonary function, chronic inflammation and aerosol distribution) or to be a separate condition occurring more in CF. Furthermore, certain characteristics of the aerosol solution itself, such as the active molecule, chemical additives and particle size, can cause BHR.Recombinant human DNase (rhDNase), hypertonic saline (HS) and the antibiotics tobramycin, colistin and aztreonam lysine for inhalation (AZLI) are frequently used inhalation drugs in the treatment of CF. Prevalence of BHR related to both short and long-term inhalation of these drugs as reported in the literature was investigated. Acute BHR is documented in up to two thirds of CF patients. Despite the widespread use of rhDNase, HS, tobramycin, colistin and AZLI, only one long-term trial looked for, but did not demonstrate, BHR at the end of the trial period.

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Section: Bhr and Nebulized Antibioticsmentioning

confidence: 99%

Section: Bhr and Nebulized Antibioticsmentioning

confidence: 99%

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Bronchial Hyperreactivity Related to Inhalation Therapy in Cystic Fibrosis Patients

Eyns¹

2014

J Pulm Respir Med

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“…(8) In the 1970s and 1980s, the emphasis in the treatment was intravenous antibiotic therapy against infection with P. aeruginosa, and this treatment improved survival. (1) However, intravenous administration of antibiotics is limited by a series of factors: many antibiotics have poor penetration in the sputum, and require high doses to produce effective concentrations, in addition to presenting higher risks of ototoxicity, vestibulotoxicity and nephrotoxicity.…”

Section: Introductionmentioning

confidence: 99%

“…(1) In industrialized countries, the systematic use of antibiotics has resulted in an increase in the survival of these patients, from 14 years in 1969 to over 30 years in 2001. (2) However, 80% of patients with CF will be colonized with Pseudomonas aeruginosa, and 90% will evolve to terminal chronic progressive lung disease.…”

Section: Introductionmentioning

confidence: 99%

Deposição pulmonar de tobramicina inalatória antes e após fisioterapia respiratória e uso de salbutamol inalatório em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa

et al. 2009

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Objective: To evaluate whether respiratory therapy followed by the use of inhaled albuterol modifies the pulmonary deposition of inhaled tobramycin in patients with cystic fibrosis (CF) and whether pulmonary deposition correlates with disease severity or genotype. Methods: A prospective study was carried out including patients with CF older than 6 years of age and colonized with Pseudomonas aeruginosa. Exclusion criteria were pulmonary exacerbation, changes in therapy between the study phases and FEV 1 < 25%. All patients were submitted to pulmonary scintigraphy by means of a scintillation camera equipped with a low-energy all-purpose collimator in order to evaluate drug penetration following the administration of inhaled 99m Tc-tobramycin, as well as to pulmonary perfusion with 99m Tc-macroaggregated albumin (phase 1). One month later, the same procedure was performed following respiratory therapy and administration of inhaled albuterol (phase 2). Results: We included 24 patients (12 males) aged 5-27 years (mean ± SD: 12.85 ± 6.64 years). The Shwachman score (SS) was excellent/good in 8 patients, moderate/fair in 16 and poor in 0. Genotyping revealed that 7 patients were ΔF508 homozygotes, 13 were ΔF508 heterozygotes; and 4 presented other mutations. In all patients, lung deposition of tobramycin decreased in phase 2, especially in those with moderate/fair SS (p = 0.017) and in heterozygotes (p = 0.043). Conclusions:The use of a respiratory therapy technique and the administration of inhaled albuterol immediately prior to the use of inhaled tobramycin decreased the pulmonary deposition of the latter in CF patients, and this reduction correlates with disease severity and genotype.Keywords: Cystic fibrosis; Tobramycin; Respiratory therapy; Albuterol; Radionuclide imaging. ResumoObjetivo: Avaliar se a fisioterapia respiratória seguida do uso de salbutamol inalatório modifica a deposição pulmonar de tobramicina inalatória em pacientes com fibrose cística (FC) e se a deposição pulmonar apresenta correlação com a gravidade da doença ou com o genótipo. Métodos: Um estudo prospectivo foi realizado com pacientes com FC maiores de 6 anos e colonizados por Pseudomonas aeruginosa. Os critérios de exclusão foram exacerbação pulmonar, mudança terapêutica entre as fases do estudo e FEV 1 < 25%. Todos os pacientes foram submetidos à cintilografia pulmonar com câmara de cintilação com um colimador low energy all purpose para avaliar a penetração da droga após a inalação de tobramicina marcada com tecnécio ( 99m Tc-tobramicina), e à perfusão pulmonar com 99m Tc-macroagregados de albumina (fase 1). Após um mês, foi realizado o mesmo procedimento precedido de fisioterapia respiratória e administração de salbutamol inalatório (fase 2). Resultados: Foram incluídos 24 pacientes (12 masculinos) com idade variando de 5 a 27 anos (média ± dp: 12,85 ± 6,64 anos). O escore de Shwachman (ES) foi excelente/bom em 8 pacientes, moderado/regular em 8 e grave em 0. A genotipagem revelou que 7 pacientes eram ΔF508 homozigotos, 13 eram ΔF...

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Exploring the role of antibiotics and steroids in managing respiratory diseases

Chellappan

Prasher

Shukla

et al. 2022

J Biochem & Molecular Tox

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Respiratory diseases (RDs), such as chronic obstructive pulmonary disease, cystic fibrosis, asthma, and pneumonia, are associated with significant morbidity and mortality. Treatment usually consists of antibiotics and steroids. Relevant published literature reviews, studies, and clinical trials were accessed from institutional and electronic databases. The keywords used were respiratory diseases, steroids, antibiotics, and combination of steroids and antibiotics. Selected articles and literature were carefully reviewed. Antibiotics are often prescribed as the standard therapy to manage RDs. Types of causative respiratory pathogens, spectrum of antibiotics activity, route of administration, and course of therapy determine the type of antibiotics that are prescribed. Despite being associated with good clinical outcome, treatment failure and recurrence rate are still high. In addition, antibiotic resistance has been widely reported due to bacterial mutations in response to the use of antibiotics, which render them ineffective. Nevertheless, there has been a growing demand for corticosteroids (CS) and antibiotics to treat a wide variety of diseases, including various airway diseases, due to their immunosuppressive and anti‐inflammatory properties. The use of CS is well established and there are different formulations based on the diseases, such as topical administration, tablets, intravenous injections, and inhaled preparations. Both antibiotics and CS possess similar properties in terms of their anti‐inflammatory effects, especially regulating cytokine release. Thus, the current review examines and discusses the different applications of antibiotics, CS, and their combination in managing various RDs. Drawbacks of these interventions are also discussed.

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Aerosol antibiotic treatment in cystic fibrosis.

Cited by 31 publications

References 40 publications

Bronchial Hyperreactivity Related to Inhalation Therapy in Cystic Fibrosis Patients

Bronchial Hyperreactivity Related to Inhalation Therapy in Cystic Fibrosis Patients

Deposição pulmonar de tobramicina inalatória antes e após fisioterapia respiratória e uso de salbutamol inalatório em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa

Exploring the role of antibiotics and steroids in managing respiratory diseases

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