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There is no cure for cystic fibrosis but recent advances in care have increased the average life expectancy to over 30 years. However, patients may find themselves prescribed over seven to eight different medications a day, some of which are laborious and time consuming to administer. The physician should balance potential benefits from treatments against quality-of-life requirements. In this review, the authors examine the place in the overall treatment regimen of recently available, and often expensive, drugs. The review concentrates on eradication regimens for early or recurrent Pseudomonas aeruginosa infection; inhaled tobramycin therapy; regular versus on-demand intravenous antibiotics; treatment of respiratory methicillin-resistant Staphylococcus aureus infection; the role of macrolide antibiotics and the role of inhaled dornase alfa in early treatment.

Objectives Allergic Bronchopulmonary Aspergillosis syndrome (ABPAs) occurs in 10 to 15% of the CF patients. We intend to study facilitators and consequences of ABPAs in P. aeruginosa (Ps) colonized CF patients. Methods Sixty four ABPAs and Ps colonized patients matched for age and gender were compared to 128 controls. FEV1, FVC, infectious exacerbations and BMI were studied 10 years before until 10 years after the index year. Results On the index year no differences were found for BMI, FVC and FEV1. Patients with ABPAs have a higher prevalence of CFRD and significantly more were on treatment with inhaled corticosteroids, RhDnase, azithromycin and inhaled tobramycin. Cumulative values (FEV1, FVC, days of IV antibiotics) over the period before the index year were similar, over the 10 years period after the index year significantly lower values for FEV1 (p Significantly more patients with ABPAs had at least one positive culture for A. fumigatus (p Conclusion In chronic Ps colonized CF patients lower lung function values are not a facilitating factor for ABPAs. Inhaled corticosteroids, RhDnase, azithromycin and inhaled tobramycin were significantly more prevalent in the ABPA group. ABPAs patients needed significantly more antibiotics, in contrast with controls, after than before the index year.

Nosocomial pneumonia (NP) occurs in 30 to 50% of multiple trauma patients. It is mostly caused by multiresistant Gram-negative bacteria. Use of inhaled antibiotics as adjuncts to systemic antibiotics presents a great outlook for the prevention of NP in multiple trauma patients. The aim of the study was to evaluate the efficacy of early administration of inhaled tobtamycin (IT) as an adjunct to systemic antibiotics for the prevention of NP in polytrauma.

It is well-known that inhaled tobramycin is safe and effective for the treatment of Pseudomonas lung infections.[1][1] The majority of investigations of inhaled tobramycin have involved patients with cystic fibrosis. Inhalation of tobramycin delivers the drug directly to the site of infection in the

Objective: to evaluate the efficiency of using inhaled tobramycin in addition to systemic antibacterial therapy in the treatment of severe nosocomial pneumonias (NP) in critically ill patients. NP remains one of the most urgent problems in resuscitative units. Traditional intravenous injection of broad-spectrum antibiotics does not allow their bactericidal concentration to be achieved in the lung. Inhaled antibiotics in addition to systemic antibacterial therapy reduce the clinical symptoms of NP, assist the switching of patients to spontaneous breathing, and decrease the titer of microbes in bronchial lavage fluid. Subject and methods. This paper describes the experience of successfully using inhaled tobramycin during systemic antibiotic therapy in 10 patients with severe NP. Results. The use of inhaled tobramycin in addition to systemic antibiotic therapy is accompanied by a reduction in the signs of endogenous intoxication and acute respiratory failure, by a decrease in the titer of pathogenic microorganisms in bronchial alveolar fluid, and by an increase in their response to systemic antibiotics, by positive X-ray changes in 60% of the patients, and by the switch of 30% of the patients to spontaneous breathing. Adverse reactions as oto- and vestibu-lotoxicity were recorded in two patients; there were no cases of nephrotoxicity. Conclusion. The administration of inhaled tobramycin in a dose of 300 mg twice daily is effective and safe as a supplement to systemic antibiotic therapy in the treatment of severe NP caused by polyresistant gram-negative pathogens. Key words: nosocomial pneumonia, inhaled tobramycin.

Background Several guidelines on infection control and treatment of infection exist for cystic fibrosis (CF) caregivers, although the extent of implementation is variable. Methods Adherence to European Consensus Guidelines for CF was studied by sending surveys to named healthcare professionals in 487 European CF centres/units. Qualitative data analysis was performed. Results A total of 177/547 (32%) surveys were returned. Infection control policies were implemented by most (77%) respondents. Separation of patients with Burkholderia cepacia was more common in adults (95%) than children (9%), and was implemented by 53% of respondents for Pseudomonas aeruginosa . Nebulised colistin plus oral ciprofloxacin was the most common (43%) therapy for P. aeruginosa infection. First infections of P. aeruginosa were usually treated with inhaled tobramycin; 41% of repondents did not intervene until lung function deteriorated. Most exacerbations were treated for less than the recommended period. Conclusions European Consensus Guidelines are widely adhered to. Areas for improvement include: initiating therapy for exacerbations early, separating infected patients and optimising duration of antibiotic therapy.

BackgroundInhaled tobramycin therapy has been shown to be efficacious in clinical trials for the eradication of initial Pseudomonas aeruginosa infection in children with cystic fibrosis (CF). However, the effectiveness of different regimens in eradicating P. aeruginosa and preventing the development of chronic infection in actual clinical settings has yet to be determined.MethodsThis was an observational study of children (

Antibiotic abuse for treating rhinopharyngitis induces the occurrence of resistant bacteria. As topical drugs might reduce this phenomenon, the aims of our study were to evaluate inhaled tobramycin in children with acute bacterial rhinopharyngitis and to compare it with oral amoxicillin/clavulanate. The trial was conducted as randomized, parallel group and double blind. Children, aged 3–6 years, with acute bacterial rhinopharyngitis were treated with 15 mg of aerosolized tobramycin (Group A) or 50 mg/Kg of amoxicillin/clavulanate (Group B) twice daily for 10 days. The following parameters were assessed: nasal obstruction, mucopurulent rhinorrhea, post-nasal drip, adenoidal hypertrophy, tympanic inflammation, tympanogramm, rhinomanometry and cultures. Of 416 patients screened, 311 children (178 females and 133 males), median age 4.5 years, completed the study: 156 in Group A and 155 in Group B. Both treatments improved all parameters (p

De mauvaises conditions de prelevement de sang au bout du doigt chez un enfant entrainent des concentrations excessivement elevees de Tobramycine. Le prelevement par voie intraveineuse et en prenant des precautions pour empecher l'exposition de la peau au medicament permettent de trouver des concentrations valables

Nosocomial pneumonia (NP) is frequently caused by multiresistant Gram-negative bacteria. The inhaled antibiotics provide us with a new treatment modality for NP in sepsis. The aim of this study was to estimate the efficacy of inhaled tobramycin (IT) as an adjunct to systemic antibiotics in the treatment of NP in sepsis.