Use of inhaled antibiotics among Danish patients with cystic fibrosis

Abstract

Background: Inhaled antibiotics are an important part of cystic fibrosis (CF) airway disease management and should be individualized to fit the microorganism and match patient needs. To investigate the implementation of personalized treatment, this study mapped the use of different types of inhaled antibiotics and adherence patterns. Methods: We performed individual structured interviews in a cross-sectional study at the CF Centre in Copenhagen, Denmark. Patients with CF older than 15 years attending clinical consultations were included. Clinical data were obtained from centralized databases.Results: Among 149 participants, 107 (72%) had indication for treatment with inhaled antibiotics. In this group, 97 (91%) reported the use of inhaled antibiotics within the last 12 months. Change from one inhaled antibiotic to another during that period was reported by 31 (29%), and 17 (25%) with Pseudomonas aeruginosa had used off-label antibiotics. Adherence to a minimum of one daily dose of antibiotic was reported by 78%, while adherence to all daily doses was 28 percentage points lower. Skipping inhalations was due to side effects and doubt about the effect in less than 5% of cases. Conclusion:Change of inhaled antibiotics and use of off-label antibiotics for inhalation were common and side effects were a rare cause of nonadherence. This suggests satisfactory implementation of the principle of tailored antibiotic inhalation prescription in the Copenhagen CF population. Adherence to at least one daily inhalation dose was markedly higher than adherence to multiple daily inhalations.

Close monitoring and early intervention: management principles for cystic fibrosis in Denmark

“…This treatment regime has shown protection from chronic infection in up to 80% of patients younger than 16 years of age [15,37]. Most patients with chronic lung infections use continuous inhaled antibiotics, most commonly colistin, tobramycin, aztreonam and levofloxacin, but off-label use of other antibiotics such as, for example nebulized carbapenems, ceftazidime, amikacin, imipenem and piperacillin/tazobactam is not uncommon [38]. The paranasal sinuses are recognized as a bacterial reservoir for initial colonization and subsequent chronic lung infection.…”

Antimicrobial Strategies for Cystic Fibrosis

“…14 15 However, there are only few available antibiotics for inhalation. Some IV preparations are used off-label as nebulized therapy to bypass this obstacle, and while this approach is based on locally developed experiences, it is common in CF 13 ( Table 1 ).…”

“…10 While pharmacokinetically advantageous, inhaled therapies are less convenient for patients, and factors such as longer administration time may lead to lower adherence to nebulized antibiotics. 12,13 Development of inhaled powder devices with a much shorter administration time may help mitigate this problem, as they have been shown to increase adherence. 14,15 However, there are only few available antibiotics for inhalation.…”

Inhaled aztreonam lysine in the management ofPseudomonas aeruginosain patients with cystic fibrosis: real-life effectiveness

“…On the other hand, adherence is considered an important determinant of the effectiveness of inhaled antibiotic treatment in patients with CF and varies substantially between age groups and the complexity of the treatment regimen, time and duration of nebulisation, treatment burden and patient satisfaction 7…”