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  • Use of Aerosolized Antibiotics in Patients With Cystic Fibrosis: Future Studies

Future Studies
It is recommended that future studies of aerosolized antibiotics address the following topics: (1) pharmacologic and safety testing of other antipseu-domonal antibiotics alone or in combination; (2) efficacy trials to determine the effect of aerosolized antibiotics when used to treat pulmonary exacerbations; (3) long-term suppression trials to determine if bacteriologic and clinical effect are maintained; (4) prospective controlled trials to determine the efficacy of aerosolized antimicrobial therapy to prevent or delay chronic P aeruginosa infection. review

; (5) development of improved methods of measuring active drug in the sputum; (6) development of new aerosolized antimicrobial therapies must include extensive clinical safety and pharmacokinetics testing; (7) a phase IV study of patients receiving longer treatment with preservative-free tobramycin, 300 mg bid, is needed to address the following: (a) emergence of resistance among P aeruginosa strains; (b) molecular epidemiology of P aeruginosa isolates with MICs to tobramycin > 16 ^g/mL; (c) emergence of other intrinsically resistant pathogens such as B cepacia; (d) cross-resistance to other aminoglycosides; (e) mechanisms of aminoglycoside resistance; and (f) ongoing clinical efficacy as determined by pulmonary function; (8) studies to track the general usage of aerosolized agents are needed; (9) studies to track overall tobramycin resistance in P aeruginosa are needed that will require participation of a reference laboratory to detect high-level resistance; (10) studies to track the incidence of intrinsically resistant pathogens are needed; (11) studies of adjuvant medications such as surfactant to improve aerosolized delivery of antibiotics should be performed more extensively; and (12) studies of more rapid delivery methods such as the dry powder inhaler being developed are important as well.

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