Use of Aerosolized Antibiotics in Patients With Cystic Fibrosis: Background Review of Efficacy
Background Review of Efficacy
Investigators have primarily examined the efficacy of aerosolized antibiotics in reducing morbidity in patients in stable condition (suppression therapy), a few studies have examined the role of aerosol antibiotics as adjunctive therapy for acute exacerbations of pulmonary disease (treatment), and several have examined their role in delaying chronicPseudomonas aeruginosa infection/colonization* (prevention). Aerosolized aminoglycosides, (3-lactams, and polymyxins have been studied.
Studies Using Aminoglycosides
Aminoglycosides have been the most extensively studied class of aerosolized antibiotics. They are well-suited for inhalation because they remain bioactive when aerosolized and are poorly absorbed across epithelial surfaces. Thus, high concentrations in bronchial secretions can theoretically be achieved with minimal risk for systemic toxicity. zyrtec tablets
Suppression Therapy: In 1981, Hodson and colleagues carried out the first (to our knowledge) clinical trial of aerosolized gentamicin (Schering Corp; Kenilworth, NJ) and carbenicillin in 20 adult patients and found lung function to be modestly improved. Following this report, a number of studies with generally positive results were published in the 1980s. All but one of the studies that measured pulmonary function demonstrated significant improvement- or a slower rate of decline- during the study period. A trend toward decreased hospitalization rates was seen in four studies,-’’ and improved nutritional status was seen in two stud-ies. Interpretation of these earlier studies is hampered by small sample size, lack of appropriate controls, and failure to mask the taste of the antibiotic. Comparison between studies is difficult due to differences in dose of aminoglycoside, duration of therapy, type of nebulizers, patient ages and disease severity, and whether sputum colonization with P aeruginosa was required for study entry.