Nebulizer Therapy with Antibiotics in Chronic Suppurative Lung Disease

Abstract

Aerosolized antibiotics have been shown to be a useful modality of treatment in patients with cystic fibrosis. In this investigation we examined the utility of this treatment in patients with other chronic suppurative lung disorders. These included forty patients, thirty men and ten women with chronic airway infection (27 with bronchiectasis, 6 with chronic abscess and 7 with chronic suppurative bronchitis). Pathogenic organisms were isolated from the affected part of the lung by a fiberoptic bronchoscopy using a sterile disposable bronchial microbiology brush. Cultures from these specimens were used to determine the appropriate antibiotic. A second control group of 20 patients was treated with systemic antibiotics alone. Both systemic and aerosolized antibiotics were administered in 20 patients. A statistically significant improvement in clinical, and ventilatory functions was recorded in the first group compared to the second. Nebulized antibiotics used as adjunctive therapy in association with systemic antibiotics may offer a therapeutic advantage in chronic suppurative lung diseases.

Assessing response to treatment of exacerbations of bronchiectasis in adults

“…Sputum volume in 24 h is a potentially useful marker as it is highly pertinent to the condition, noninvasive, easily accessible and inexpensive. It has been used as a marker in previous studies that have assessed potential long-term therapeutic strategies including inhaled steroids and long-term antibiotics [16][17][18][19][20][21]. A recent study has shown wet weight sputum to be as reliable as dry sputum [22].…”

British Thoracic Society guideline for non-CFbronchiectasis

“…One study examining changes in lung function after intravenous antibiotic therapy found an increase in FEV 1 but no change in FVC,371 while increases in PEF, FEV 1 and FVC were seen in another 369. Lung function testing is an important aspect of assessing tolerability of nebulised antibiotics (Appendix 1) and can detect improvement after nebulised antibiotics 369.…”

“…Lung function testing is an important aspect of assessing tolerability of nebulised antibiotics (Appendix 1) and can detect improvement after nebulised antibiotics 369. Patients with PCD show stabilisation of lung function when managed aggressively with repeated spirometry and antibiotics 179…”

“…The studies of antibiotics in exacerbations of bronchiectasis are summarised in table AV in Appendix 2 236 237 246 368 369 424–431. The studies are heterogeneous and predominantly are in exacerbations treated in hospital.…”

“…They indicate that a successful clinical outcome (figure 3) is achievable if there is high dosage targeted antibiotic therapy. High doses are often required to achieve the sputum becoming mucoid and bacterial clearance,368 369 424 426–428 430 although these goals are not always achievable. The duration of antibiotic therapy required needs further study.…”