Summary of recent evidence for long-term inhaled antibiotic therapy
| Antibiotic class and agent | Study design | Dose and duration | Patients | Main findings |
|---|---|---|---|---|
| Monobactam: aztreonam68 | Two multicentre, double-blind, randomized placebo-controlled trials | 75 mg daily 4 weeks on, 4 weeks off for 16 weeks v. placebo Followed with 4-week open label | Study 1: n = 266 Study 2: n = 274 Criterion: Chronic sputum colonization with gram-negative pathogens (but not exclusively Haemophilus influenzae) | No improvement in respiratory symptoms; time to first exacerbation not prolonged; more treatment-related adverse events; more discontinuations with treatment than placebo |
| Polymyxin: colistin69 | Multicentre, randomized, double-blind, placebo-controlled trial | 1 million IU twice daily v. placebo for 6 months | n = 144 Criterion: chronic sputum colonization with Pseudomonas aeruginosa | Reduced sputum bacterial density; increased time to first exacerbation; improved HRQL |
| Quinolone: ciprofloxacin70 | Multicentre, randomized, double-blind, placebo-controlled trial | Dual-release liposomal ciprofloxacin 150/60 mg 28 days on, 28 days off v. placebo for 24 weeks | n = 42 Criterion: Chronic sputum colonization with P. aeruginosa | Reduced sputum bacterial density; fewer exacerbations; well tolerated |
| Quinolone: ciprofloxacin71 | Multicentre, randomized, double-blind, placebo-controlled trial | Dry powder inhaled ciprofloxacin 32.5 mg twice daily for 28 days | n = 124 Criterion: Chronic sputum colonization with any pathogen | Reduced sputum bacterial density; improved sputum purulence; 35% pathogen eradication |
| Aminoglycoside: gentamicin72 | Randomized, single-blind controlled trial | 80 mg nebulized twice daily v. placebo for 12 months with 3-month follow-up | n = 60 Criterion: Chronic sputum colonization with any pathogen | Reduced sputum bacterial density; 30.8% Pseudomonas eradication and 92.8% eradication in other pathogens; reduced airways inflammation; improved exercise capacity; improved HRQL; fewer exacerbations; increased time to first exacerbation; treatment effects not sustained during follow-up |
Note: HRQL = health-related quality of life, IU = international units.