Inhaled antibiotics for pulmonary exacerbations in cystic fibrosis

Abstract

Background Cystic fibrosis is a genetic disorder in which abnormal mucus in the lungs is associated with susceptibility to persistent infection. Pulmonary exacerbations are when symptoms of infection become more severe. Antibiotics are an essential part of treatment for exacerbations and inhaled antibiotics may be used alone or in conjunction with oral antibiotics for milder exacerbations or with intravenous antibiotics for more severe infections. Inhaled antibiotics do not cause the same adverse e ects as intravenous antibiotics and may prove an alternative in people with poor access to their veins. This is an update of a previously published review. Objectives To determine if treatment of pulmonary exacerbations with inhaled antibiotics in people with cystic fibrosis improves their quality of life, reduces time o school or work and improves their long-term survival. Search methods We searched the Cochrane Cystic Fibrosis Group's Cystic Fibrosis Trials Register.

Keep cystic fibrosis patients out of the hospital

“…The role of inhaled antibiotics during an acute pulmonary exacerbation is controversial, 5 and holding inhaled antibiotics altogether or considering using inhaled tobramycin powder would be reasonable.…”

Antimicrobial Resistance in Common Respiratory Pathogens of Chronic Bronchiectasis Patients: A Literature Review

“…Subsequently, in the last decade, several formulations for inhalation have been developed, including different solutions for nebulization or the use of dry powder. Most of the evidence derives from studies with CF patients, where a number of antibiotics such as tobramycin, colistin, and aztreonam have shown significant improvement in QoL and a reduced number of exacerbations, as well as lung function decline [ 82 , 83 ]. Similar to what has been observed in studies conducted on CF patients, inhaled antibiotics have also been tested in patients with NCFB resulting in reduction of symptoms, exacerbations, systemic use of antibiotics, functional decline, and healthcare expenditure [ 84 ].…”

Cystic Fibrosis–Associated Liver Disease in Lung Transplant Recipients

“…If the exacerbation is thought to be caused by gram‐negative bacteria, it is usually treated with IV antibiotics for 14 days . Recent reviews confirmed that although the use of inhaled antibiotics decreases the frequency of exacerbations in CF patients infected with P. aeruginosa , there was insufficient evidence to support their use in the treatment of an acute exacerbation . Severe exacerbations might require the use of noninvasive positive pressure ventilation and supplemental oxygen …”

“…(11,12) Recent reviews confirmed that although the use of inhaled antibiotics decreases the frequency of exacerbations in CF patients infected with P. aeruginosa, there was insufficient evidence to support their use in the treatment of an acute exacerbation. (13,14) Severe exacerbations might require the use of noninvasive positive pressure ventilation and supplemental oxygen. (11) cF tReAtMent witH cFtR MoDUlAtoRs CFTR modulators increase the number of CFTRs in the cell membrane (correctors), enhance the activity of mutant CFTRs in the cell surface (potentiators), or suppress premature stop codons during protein translation (read-through agents).…”