Use of Aerosolized Antibiotics in Patients With Cystic Fibrosis: Recommendations
3. Aerosolized preservative-free tobramycin might be considered for bacterial suppression in other patients. For example, a logical extrapolation of these data suggests that this therapy may also be efficacious in patients < 6 years of age, patients with FEV1 < 25% or > 75% predicted, and patients colonized with other pathogens susceptible to tobramycin. However, to our knowledge, there are no data to support these extrapolations (consensus grade III).
4. Currently, we know of no studies supporting the routine use of aerosolized antibiotics as a replacement for, or as adjunct to, parenteral antibiotics for the treatment of a CF pulmonary exacerbation. The efficacy of aerosolized preservative-free tobramycin for the treatment of CF exacerbations has not been examined. Based on the clinical experience of CF physicians at the Consensus Conference, there may be individual situations when an aerosolized antibiotic may be used by itself or together with parenteral antibiotics and/or an oral fluoroquinolone for the treatment of a pulmonary exacerbation (consensus grade III).
Comment: Potential examples of such practices include, but are not limited to the following: (1) aerosolized antibiotics alone for a mild CF pulmonary exacerbation; (2) aerosolized antibiotics added to parenteral antibiotics for CF pulmonary exacerbations complicated by a resistant organism; and (3) aerosolized antibiotics added to oral fluoroquinolones for an uncomplicated CF pulmonary exacerbation. so
5. Currently there have been no studies (to our knowledge) conducted to assess the ability of aerosolized antibiotics to prevent acquisition of P aeruginosa (consensus grade III).
What Is the Appropriate Dosage and Method of Delivery for Aerosolized Antibiotics?
Since the 1960s, it has been known that the sputum of CF patients can antagonize the bioactivity of antibiotics such as neomycin and polymyxin.- Aerosol antibiotic administration has been part of therapeutic regimens for patients with CF since 1964. However, only recently have the following factors been considered: the amount of drug needed in the lower respiratory tract to overcome sputum antagonism; the efficiency of aerosol delivery; and the particle size of nebulizer output necessary to deposit drug in the lower respiratory tract.