Gentamicin and tobramycin compared in the treatment of mucoid pseudomonas lung infections in cystic fibrosis.

Abstract

SUMMARY 18 children with cystic fibrosis and mucoid pseudomonas lung infection were treated with courses either of gentamicin plus carbenicillin, or tobramycin plus carbenicillin, with 2 children each receiving two courses. 10 courses of gentamicin at a dose of 9 mg/kg per day plus carbenicillin at 800 mg/kg per day, and 10 courses oftobramycin at 9 mg/kg per day plus carbenicillin at 800 mg/kg per day were given. There was clinical and x-ray improvement in both groups of children, but there was no difference between the therapeutic benefit of either regimen. Pseudomonas aeruginosa was not cultured at the end of treatment after 15 of the 20 courses, but it returned in all but one patient within 3 months. Neither ototoxicity nor renal damage with these high doses of aminoglycoside was detected. P. aeruginosa had not been eliminated when 9 of these patients earlier had received courses of gentamicin in a dose of 6 mg/kg per day plus carbenicillin at 800 mg/kg per day. The results show that P. aeruginosa can successfully be eliminated or suppressed with high-dose aminoglycoside plus carbenicillin, but such elimination is usually short lived.

Optimization of anti‐pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: V. Aminoglycosides

“…There were no significant differences found between groups. There were no changes in BUN, electrolytes, or LFT's during the trial (Tables and ) …”

“…Penketh et al did not report any changes in BUN from baseline (Table ). In a study by Martin et al, gentamicin or tobramycin (9 mg/kg/day divided TID) plus carbenicillin (800 mg/kg/day divided every 6 hr) were utilized for the treatment of APE in pediatric CF patients . Both groups experienced significant improvements in clinical and modified X‐ray scores ( P < 0.001).…”

“…There were no changes in BUN, electrolytes, or LFT's during the trial (Tables 4 and 5). 66 However, IV gentamicin is not recommended for use in CF patients due to the high potential for inducing renal failure (Table 5). 9,67-69 A small case report by Drew et al 67 showed that over a 9-month period, three CF patients (ages 4 months to 9 years) developed acute renal failure (ARF) and acute tubular necrosis (ATN) while receiving appropriately dosed gentamicin and ceftazidime.…”

Cystic fibrosis, pathophysiological and clinical aspects

“…The various aminoglycosides [38,58], and the various ureidopenicillins (azlo-, meslo-and piperacillin) [64,73,84] do not seem to have clear differences in efficacy. Piperacillin may produce serum-sickness-like symptoms, and these seem to be relatively common in CF patients [104].…”

FREQUENT ANTIBIOTIC THERAPY IMPROVES SURVIVAL OF CYSTIC FIBROSIS PATIENTS WITH CHRONIC PSEUDOMONAS AERUGINOSA INFECTION

“…In agreement with other authors we have shown that P. aeruginosa is at best only temporarily eradicated. Nevertheless, the shorttime effect of a 14 day-course of anti-pseudomonas chemotherapy is improved lung function, decreased inflammatory parameters, decreased proteolytic activity in sputum, and improved well-being of the patient (1, 5, 6,[13][14][15][16][17][18][19][20][21][22][23][24]. After the completion of the courses of chemotherapy, the lung function gradually returns to pretreatment level after a period of 1-3 months (1).…”