Use of Aerosolized Antibiotics in Patients With Cystic Fibrosis
There has been a renewed interest in the use of aerosolized antibiotics in cystic fibrosis (CF) patients during the past decade. Potential benefits of delivering antibiotics by aerosol include the following: direct delivery of antibiotics to the endobronchial site of infection; decreased toxicity as systemic absorption is limited; reduced cost; and less disruption to patients’ lives, especially when compared with IV antibiotic administration. Several reviews have summarized the published literature on the sub-ject.
Purpose of Consensus Document
The authors of this document were convened to discuss the use of aerosolized antibiotics in CF patients. The document attempts to address four major questions: (1) What are the indications for the use of aerosolized antibiotics? (2) What is the appropriate dosage and delivery method for aerosolized agents? (3) How should patients receiving aerosolized antibiotics be monitored? (4) What are the microbiological implications of aerosolized antibiotics?
Each section of this document contains a review of the published literature. Whenever possible, evidence-based recommendations are made. The grading of evidence for our recommendations follows the US Preventive Services Task Force system. In addition, words defined in the glossary found in the appendix will be indicated by an asterisk (*) the first time they are used in the text. add comment
Grading of Evidence
I Evidence obtained from at least one properly randomized controlled trial.
II-1 Evidence obtained from well-designed controlled trials without randomization.
II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.
III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
What Are the Indications for the Use of Aerosolized Antibiotics?