Comparative efficacy and safety of four randomized regimens to treat early Pseudomonas aeruginosa infection in children with cystic fibrosis

Treggiari, M.; Retsch-Bogart, G.; Mayer-Hamblett, Nicole; Khan, Umer; Kronmal, Richard; Ramsey, Bonnie W.; Accurso, FJ

doi:10.1016/s1569-1993(10)60210-x

Cited by 34 publications

(46 citation statements)

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“…This approach was championed by the Copenhagen Centre, who in early studies of this intervention using a historical comparative cohort, showed that there was a strong indication that the combination of inhaled colistin and oral ciprofloxacin resulted in approximately an 80% success in P. aeruginosa eradication (Valerius et al 1991). Subsequent studies, such as the ELITE and EPIC studies, have shown that inhaled tobramycin for 4 wk is also an effective antibiotic eradication therapy (Ratjen et al 2010;Treggiari et al 2011). In two small studies, no difference was identified between these two regimes with a comparable eradication rate (Taccetti et al 2012;Proesmans 2013).…”

Section: Antibiotic Therapy For Infection With P Aeruginosa Eradicatmentioning

confidence: 99%

Antibiotic and Anti-Inflammatory Therapies for Cystic Fibrosis

Chmiel

Konstan

Elborn

2013

Cold Spring Harbor Perspectives in Medicine

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Section: Antibiotic Therapy For Infection With P Aeruginosa Eradicatmentioning

confidence: 99%

Antibiotic and Anti-Inflammatory Therapies for Cystic Fibrosis

Chmiel

Konstan

Elborn

2013

Cold Spring Harbor Perspectives in Medicine

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“…Its use is increasing in infants and young children with different conditions. [1][2][3][4][5][6] National and international guidelines recommend the use of inhaled albuterol, ipratropium bromide, and corticosteroids for asthma treatment. 7,8 The guidelines also recommend the use of specific interfaces for different age groups and situations.…”

Section: Introductionmentioning

confidence: 99%

“…Hypertonic saline has been used in several clinical trials in subjects with bronchiolitis, and inhaled antibiotics, inhaled 7% hypertonic saline, and dornase alfa are being used in infants and young children with cystic fibrosis. [2][3][4][5][6] Several factors are known to affect drug delivery to a patient and can be divided into aerosol-related and patientrelated factors. 9 Aerosol-related factors include type of aerosol generator, patient interface, particle size, treatment time, mask dead volume, type of power gas, and type of solution.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Evaluation of Aerosols Delivered via the Nasal Route

Taoum

Kim

et al. 2015

Respir Care

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BACKGROUND: Infants and young children are obligate nose breathers; therefore, a transnasal route seems the logical delivery method of inhaled aerosols. The efficiency of aerosol delivery depends on several factors, such as interface, type of nebulizer, and patient age and breathing pattern. We hypothesized that the use of a vibrating mesh nebulizer, a tight-fitting face mask, and a head model and breathing pattern of an older child would result in a higher lung dose. We also hypothesized that the use of an anatomically correct model would more accurately reflect lung dose than models that do not include airways. METHODS: A model comprising a breathing simulator and an anatomically correct model of a 7-month-old infant and a 5-y-old child with an interposed collection filter (lung dose) were used. Breathing patterns of a newborn, infant, and child were used with 7 interfaces. A continuous output and a vibrating mesh nebulizer were loaded with albuterol sulfate solution (5 mg/3.5 mL) and operated for 5 min. Albuterol mass was determined via spectrophotometer (276 nm). RESULTS: Lung dose varied between 0 and 3%. The jet nebulizer was more efficient than the vibrating mesh nebulizer. The front-loaded mask was the most efficient interface. We also found that higher tidal volumes were associated with higher lung doses and that the use of a larger airway model resulted in a lower lung dose. Finally, the model showed a good correlation with in vivo data and rendered lung doses severalfold lower than previous data obtained with oral models. CONCLUSIONS: Careful pairing of the aerosol generator and interface is very important during transnasal aerosol delivery.

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“…Eradication of P. aeruginosa in patients at initial onset of infection has been well studied in the young, pediatric population (18)(19)(20). These large, well-designed studies have demonstrated that P. aeruginosa can be eradicated in both the lower and upper airways in the majority of patients, and patients remain P. aeruginosa free for months (21), even with inhaled tobramycin monotherapy (18).…”

Section: Cystic Fibrosismentioning

confidence: 99%

Inhaled Antibiotics for Lower Airway Infections

2014

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Inhaled antibiotics have been used to treat chronic airway infections since the 1940s. The earliest experience with inhaled antibiotics involved aerosolizing antibiotics designed for parenteral administration. These formulations caused significant bronchial irritation due to added preservatives and nonphysiologic chemical composition. A major therapeutic advance took place in 1997, when tobramycin designed for inhalation was approved by the U.S. Food and Drug Administration (FDA) for use in patients with cystic fibrosis (CF) with chronic Pseudomonas aeruginosa infection. Attracted by the clinical benefits observed in CF and the availability of dry powder antibiotic formulations, there has been a growing interest in the use of inhaled antibiotics in other lower respiratory tract infections, such as non-CF bronchiectasis, ventilator-associated pneumonia, chronic obstructive pulmonary disease, mycobacterial disease, and in the post-lung transplant setting over the past decade.Antibiotics currently marketed for inhalation include nebulized and dry powder forms of tobramycin and colistin and nebulized aztreonam. Although both the U.S. Food and Drug Administration and European Medicines Agency have approved their use in CF, they have not been approved in other disease areas due to lack of supportive clinical trial evidence. Injectable formulations of gentamicin, tobramycin, amikacin, ceftazidime, and amphotericin are currently nebulized "off-label" to manage non-CF bronchiectasis, drug-resistant nontuberculous mycobacterial infections, ventilatorassociated pneumonia, and post-transplant airway infections. Future inhaled antibiotic trials must focus on disease areas outside of CF with sample sizes large enough to evaluate clinically important endpoints such as exacerbations. Extrapolating from CF, the impact of eradicating organisms such as P. aeruginosa in non-CF bronchiectasis should also be evaluated.

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Comparative efficacy and safety of four randomized regimens to treat early Pseudomonas aeruginosa infection in children with cystic fibrosis

Cited by 34 publications

References 0 publications

Antibiotic and Anti-Inflammatory Therapies for Cystic Fibrosis

Antibiotic and Anti-Inflammatory Therapies for Cystic Fibrosis

In Vitro Evaluation of Aerosols Delivered via the Nasal Route

Inhaled Antibiotics for Lower Airway Infections

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