Table 5:

Summary of recent evidence for long-term inhaled antibiotic therapy

Antibiotic class and agentStudy designDose and durationPatientsMain findings
Monobactam: aztreonam (68)Two multicentre, double-blind, randomized placebo-controlled trials75 mg daily 4 weeks on, 4 weeks off for 16 weeks v. placebo Followed with 4-week open labelStudy 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: colistin (69)Multicentre, randomized, double-blind, placebo-controlled trial1 million IU twice daily v. placebo for 6 monthsn = 144
Criterion: chronic sputum colonization with Pseudomonas aeruginosa
Reduced sputum bacterial density; increased time to first exacerbation; improved HRQL
Quinolone: ciprofloxacin (70)Multicentre, randomized, double-blind, placebo-controlled trialDual-release liposomal ciprofloxacin 150/60 mg 28 days on, 28 days off v. placebo for 24 weeksn = 42
Criterion: Chronic sputum colonization with P. aeruginosa
Reduced sputum bacterial density; fewer exacerbations; well tolerated
Quinolone: ciprofloxacin (71)Multicentre, randomized, double-blind, placebo-controlled trialDry powder inhaled ciprofloxacin 32.5 mg twice daily for 28 daysn = 124
Criterion: Chronic sputum colonization with any pathogen
Reduced sputum bacterial density; improved sputum purulence; 35% pathogen eradication
Aminoglycoside: gentamicin (72)Randomized, single-blind controlled trial80 mg nebulized twice daily v. placebo for 12 months with 3-month follow-upn = 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.