Inhaled Colistin in Patients with Bronchiectasis and Chronic <i>Pseudomonas aeruginosa</i> Infection

Haworth, Charles; Foweraker, Juliet; Wilkinson, Peter; Kenyon, Robert F.; Bilton, Diana

doi:10.1164/rccm.201312-2208oc

Cited by 249 publications

(258 citation statements)

References 31 publications

(41 reference statements)

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Section: Inhaled Antibioticsmentioning

confidence: 99%

“…HAWORTH et al [83] studied nebulised colistin delivered via the I-Neb (Philips Respironics, Chichester, UK) device. This trial recruited 144 patients with chronic P. aeruginosa colonisation in the UK, Russia and Ukraine [83]. The primary outcome was the time to next exacerbation, and the study narrowly failed to meet this end-point (colistin group 165 days versus placebo 111 days; p=0.11).…”

Section: Inhaled Antibioticsmentioning

confidence: 99%

“…In the secondary end-points, a large improvement in quality of life using the SGRQ was noted (mean difference −10.5 points; p=0.006). The I-Neb device allows the monitoring of compliance and, in a pre-specified analysis based on patients that took >80% of the doses, a statistically significant difference in time to first exacerbation was seen [83].…”

Section: Inhaled Antibioticsmentioning

confidence: 99%

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Management of bronchiectasis in adults

2015

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Formerly regarded as a rare disease, bronchiectasis is now increasingly recognised and a renewed interest in the condition is stimulating drug development and clinical research. Bronchiectasis represents the final common pathway of a number of infectious, genetic, autoimmune, developmental and allergic disorders and is highly heterogeneous in its aetiology, impact and prognosis.The goals of therapy should be: to improve airway mucus clearance through physiotherapy with or without adjunctive therapies; to suppress, eradicate and prevent airway bacterial colonisation; to reduce airway inflammation; and to improve physical functioning and quality of life.Fortunately, an increasing body of evidence supports interventions in bronchiectasis. The field has benefited greatly from the introduction of evidence-based guidelines in some European countries and randomised controlled trials have now demonstrated the benefit of long-term macrolide therapy, with accumulating evidence for inhaled therapies, physiotherapy and pulmonary rehabilitation.This review provides a critical update on the management of bronchiectasis focussing on emerging evidence and recent randomised controlled trials. @ERSpublications Bronchiectasis is a rapidly developing field: review of recent RCTs and progress towards developing new therapies

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Section: Inhaled Antibioticsmentioning

confidence: 99%

Section: Inhaled Antibioticsmentioning

confidence: 99%

Section: Inhaled Antibioticsmentioning

confidence: 99%

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Management of bronchiectasis in adults

2015

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“…In the first controlled clinical trial to use an adaptive aerosol delivery device, patients with non-CF bronchiectasis and chronic P. aeruginosa infection were randomized to receive either inhaled colistin or placebo after receiving systemic antibiotics for an acute exacerbation. Of the patients with documented adherence to treatment, the time to next exacerbation significantly improved (224).…”

Section: Non-cf Bronchiectasismentioning

confidence: 98%

“…Patients with non-CF bronchiectasis may be more difficult to treat than CF bronchiectasis patients, as other studies evaluating inhaled antibiotics have also failed to show an improvement in FEV 1 , which may be due in part to non-CF bronchiectasis being precipitated by a fixed airflow obstruction in many cases (222)(223)(224). A limitation to the studies examining inhaled antimicrobials for non-CF bronchiectasis is a lack of information regarding the pathophysiology of the disease.…”

Section: Non-cf Bronchiectasismentioning

confidence: 99%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

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SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

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