Eradication Therapy against <b><i>Pseudomonas aeruginosa</i></b> in Non-Cystic Fibrosis Bronchiectasis

Abstract

Background: No prospective study has assessed eradication treatment of early Pseudomonas aeruginosa colonisation in bronchiectasis not due to cystic fibrosis (CF). Objectives: To evaluate the efficacy of 3 months of nebulised tobramycin after a short course of intravenous antibiotics in the eradication of P. aeruginosa and its clinical consequences in non- CF bronchiectasis following initial P. aeruginosa infection. Methods: A 15-month, single-masked, randomised study including 35 patients was conducted in a tertiary university hospital. Following the isolation of P. aeruginosa and a 14-day intravenous treatment with ceftazidime and tobramycin, patients received 300 mg nebulised tobramycin twice daily or placebo during 3 months, and were followed up for 12 months thereafter. Results: The median time to recurrence of P. aeruginosa infection was higher in the tobramycin than in the placebo group (p = 0.048, log-rank test). At the end of the study 54.5% of the patients were free of P. aeruginosa in the tobramycin group and 29.4% in the placebo group. The numbers of exacerbations (p = 0.044), hospital admissions (p = 0.037) and days of hospitalisation (p = 0.034) were lower in the tobramycin than in the placebo group. A global, non-significant trend to improvement in the tobramycin group was observed in most of the other studied parameters on comparing the two groups. Bronchospasm in the tobramycin group was remarkable. Conclusions: Our study shows that 3 months of nebulised tobramycin following a short course of intravenous antibiotics may prevent bronchial infection with P. aeruginosa and has a favourable clinical impact on non-CF bronchiectasis.

Efficacy ofPseudomonas aeruginosaeradication regimens in bronchiectasis

“…This finding supports results recently published by Orriols et al [4]. In that study, the authors randomised 35 patients who recently acquired P. aeruginosa infection to receive 2 weeks of intravenous antibiotics (ceftazidime and tobramycin), followed by either 3 months of nebulised tobramycin or placebo.…”

“…Emilie Vallières 1,[3][4] , Karen Tumelty those who are P. aeruginosa free [1]. Guidelines published by the British Thoracic Society recommend treatment to eradicate P. aeruginosa when first isolated in respiratory tract samples of people with bronchiectasis [2].…”

Cost of Hospitalizations due to Exacerbation in Patients with Non-Cystic Fibrosis Bronchiectasis

“…CBI by PA was also independently associated with a longer total treatment period. It is already well known that CBI by PA is associated with a poor clinical evolution in patients with BE [21], and so when these patients are admitted to hospital, they are treated with prolonged intravenous antibiotic therapy to eradicate or reduce this microorganism's bacterial load [23,24], according to current guidelines [14]. The high percentage of CBI by PA in our study may have propitiated a longer hospitalization, which was even longer in those patients who completed their treatment with HH.…”

British Thoracic Society Guideline for bronchiectasis in adults

“…283 The number of exacerbations (1.27±1.62 vs 2.5±1.63, P=0.04), the number of hospital admissions (0.06±0.25 vs 0.47±0.51, P=0.04) and the number of days in hospital (0.90±3.01 vs 13.56±22.64, P=0.03) were also significantly lower in the nebulised tobramycin group. Five patients in the nebulised tobramycin group discontinued treatment due to bronchospasm and two patients in the placebo group withdrew from the study.…”