Use of Aerosolized Antibiotics in Patients With Cystic Fibrosis: Recommendations for Monitoring CF Patients Receiving Aerosolized Antibiotics
4. Monitoring for eighth nerve toxicity should include an audiogram (500 to 8,000 Hz range) after two to four courses of IV therapy or 180 accumulated days of aerosol therapy (consensus grade III).
5. The initial dose of a newly prescribed aerosolized antibiotic should be given in the presence of an appropriately trained health-care provider to monitor for wheezing, respiratory distress, and to instruct in proper technique. Patients should be trained to monitor themselves for potential bronchospasm and to immediately stop taking the medication and administer a bronchodilator if indicated (consensus grade III).
6. If a patient experiences an adverse reaction (bronchospasm, chest tightness, anaphylaxis, urticaria, perioral or periorbital edema) during an inhalation treatment, the patient should stop taking the drug and consult his/her physician. If indicated, subsequent drug administration should occur in the presence of a health-care provider (consensus grade III). website
7. Hemoptysis is a common complication in CF patients with moderate to severe pulmonary disease. Although there is no evidence that aerosolized antibiotics increase the incidence of hemoptysis, they should be used with caution during clinically significant hemoptysis (consensus grade III).
8. PFTs are the best measure of short-term efficacy as PFT results have been shown to improve as early as 2 weeks after the initiation of therapy. Follow-up PFTs 2 to 4 weeks after starting therapy are recommended to assess efficacy (consensus grade I).
Comment: Lack of improvement 2 to 4 weeks after starting therapy does not rule out improvement later. Thirty percent of early nonresponders in phase III trials with preservative-free 300 mg of tobramycin demonstrated improvement in PFTs results by 3 months.
9. Evaluation of measures of long-term efficacy, such as a reduction in the frequency of hospitalization and IV antibiotic usage, is recommended 6 to 12 months after beginning therapy (consensus grade I).
Comment: Measuring the effect of aerosolized antibiotic use on frequency of hospitalization and IV antibiotic usage requires a longer duration of aerosolized therapy. In phase III trials with preservative-free 300 mg of tobramycin, an impact on these two measures did not occur until approximately 4 to 6 months. Some individuals who did not have significant short-term or initial improvement acutely in PFT results did demonstrate a reduction in hospitalization and/or IV usage.
10. Other long-term outcome measures that could be followed include the patient’s sense of well-being, work or school performance and absenteeism, and cough frequency (consensus grade III).
Comment: As pulmonary exacerbations will occur while patients are receiving aerosolized antibiotics, long-term efficacy should not be assessed during an acute period of increased symptoms. However, if a patient has had a consistent decline in PFT results from baseline or increased IV antibiotic usage while receiving aerosolized antibiotics, it may be necessary to reassess the patient’s microbiology status and to look for other etiologies of declining health status.