scholarly journals 117 The fate of inhaled antibiotics after deposition in patients with cystic fibrosis: how to get drug to the bug?

2016 ◽  
Vol 15 ◽  
pp. S80-S81 ◽  
Author(s):  
A.C. Bos ◽  
K.M. Passé ◽  
J.W. Mouton ◽  
H.M. Janssens ◽  
H.A.W.M. Tiddens
Keyword(s):  
Cystic Fibrosis ◽  
Inhaled Antibiotics

Case 13

2020 ◽  
pp. 81-86
Author(s):  
Hilary Humphreys
Keyword(s):  
Cystic Fibrosis ◽  
Stenotrophomonas Maltophilia ◽  
New Technologies ◽  
Microbiology Laboratory ◽  
Oral Antibiotics ◽  
Flight Mass Spectrometry ◽  
Single Room ◽  
Inhaled Antibiotics ◽  
True Infection ◽  
Opportunist Pathogen

There is an increasing number of opportunist pathogens that may cause acute pulmonary exacerbations of cystic fibrosis as the patient cohort survives longer. However, it can often be difficult to determine if the isolation of these bacteria represents colonization or true infection. Their identification from sputum samples in the microbiology laboratory is also challenging, requires significant scientific expertise, and is assisted by new technologies such as MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry). One such opportunist pathogen is Stenotrophomonas maltophilia, for which risk factors include increasing age and recent oral antibiotics, especially carbapenems. However, it is unclear if this bacterium is transmitted from patient to patient unlike with Pseudomonas aeruginosa, but all patients with cystic fibrosis should be admitted to a single room when hospitalization is required. Controversies exist regarding the optimal treatment which in the future may include a greater reliance on inhaled antibiotics.

scholarly journals Microbiological contamination of nebulizers used by cystic fibrosis patients: an underestimated problem

2019 ◽  
Vol 45 (3) ◽  
Author(s):  
Barbara Riquena ◽  
Luciana de Freitas Velloso Monte ◽  
Agnaldo José Lopes ◽  
Luiz Vicente Ribeiro Ferreira da Silva-Filho ◽  
Neiva Damaceno ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Burkholderia Cepacia ◽  
Tap Water ◽  
Significant Proportion ◽  
Burkholderia Cepacia Complex ◽  
Structured Interviews ◽  
Candida Spp ◽  
Cross Sectional ◽  
Inhaled Antibiotics ◽  
Cleaning And Disinfection

ABSTRACT Objective: Home nebulizers are routinely used in the treatment of patients with cystic fibrosis (CF). This study aims to evaluate the contamination of nebulizers used for CF patients, that are chronically colonized by Pseudomonas aeruginosa, and the association of nebulizer contamination with cleaning, decontamination and drying practices. Methods: A cross-sectional, observational, multicenter study was conducted in seven CF reference centers in Brazil to obtain data from medical records, structured interviews with patients/caregivers were performed, and nebulizer’s parts (interface and cup) were collected for microbiological culture. Results: overall, 77 CF patients were included. The frequency of nebulizer contamination was 71.6%. Candida spp. (52.9%), Stenotrophomonas maltophilia (11.9%), non-mucoid P. aeruginosa (4.8%), Staphylococcus aureus (4.8%) and Burkholderia cepacia complex (2.4%) were the most common isolated pathogens. The frequency of nebulizers’ hygiene was 97.4%, and 70.3% of patients reported cleaning, disinfection and drying the nebulizers. The use of tap water in cleaning method and outdoor drying of the parts significantly increased (9.10 times) the chance of nebulizers’ contamination. Conclusion: Despite the high frequency hygiene of the nebulizers reported, the cleaning and disinfection methods used were often inadequate. A significant proportion of nebulizers was contaminated with potentially pathogenic microorganisms for CF patients. These findings support the need to include patients/caregivers in educational programs and / or new strategies for delivering inhaled antibiotics.

Efficacy and safety of inhaled antibiotics for chronicpseudomonasinfection in cystic fibrosis: Network meta-analysis

2016 ◽  
Author(s):  
Stuart Elborn ◽  
Anne-Lise Vataire ◽  
Ayako Fukushima ◽  
Samuel Aballéa ◽  
Amine Khemiri ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Inhaled Antibiotics

scholarly journals Tobramycin Inhalation Powder (TIP): An Efficient Treatment Strategy for the Management of Chronic Pseudomonas Aeruginosa Infection in Cystic Fibrosis

2013 ◽  
Vol 7 ◽  
pp. CCRPM.S10592 ◽  
Author(s):  
John Lam ◽  
Steven Vaughan ◽  
Michael D. Parkins
Keyword(s):  
Cystic Fibrosis ◽  
Pseudomonas Aeruginosa ◽  
Treatment Strategy ◽  
Standard Of Care ◽  
Efficient Treatment ◽  
Adaptive Resistance ◽  
Inhaled Antibiotics ◽  
Pseudomonas Aeruginosa Infection ◽  
High Concentrations ◽  
Inhalation Powder

Repeated bouts of acute and chronic lung infections are responsible for progressive pulmonary function decline in individuals with cystic fibrosis (CF), ultimately leading to respiratory failure and death. Pseudomonas aeruginosa is the archetypical CF pathogen, causes chronic infection in 70% of individuals, and is associated with an accelerated clinical decline. The management of P. aeruginosa in CF has been revolutionized with the development and widespread use of inhaled antibiotics. Aerosol delivery of antimicrobial compounds in CF enables extremely high concentrations of antibiotics to be reached directly at the site of infection potentially overcoming adaptive resistance and avoiding the potential for cumulative systemic toxicities. Tobramycin inhalation powder (TIP) represents the first dry powder inhaled (DPI) antibiotic available for use in CF. DPIs are notable for a markedly reduced time for administration, ease of portability, and increased compliance. TIP has been developed as a therapeutic alternative to tobramycin inhalation solution (TIS), the standard of care for the past 20 years within CF. Relative to TIS 300 mg nebulized twice daily in on-and-off cycles of 28 days duration, TIP 112 mg twice daily via the T-326 inhaler administered on the same schedule is associated with marked time savings, increased patient satisfaction, and comparable clinical end points. TIP represents an innovative treatment strategy for those individuals with CF and holds the promise of increased patient compliance and thus the potential for improved clinical outcomes.

Candida albicanschronic colonisation in cystic fibrosis may be associated with inhaled antibiotics

Mycoses ◽  
2015 ◽  
Vol 58 (7) ◽  
pp. 416-421 ◽  
Author(s):  
Maria Noni ◽  
Anna Katelari ◽  
Athanasios Kaditis ◽  
Ioanna Theochari ◽  
Ioulia Lympari ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Inhaled Antibiotics

scholarly journals 92 Early treatment with inhaled antibiotics postpones recurrence of Achromobacter species in cystic fibrosis

2013 ◽  
Vol 12 ◽  
pp. S72
Author(s):  
M. Wang ◽  
W. Ridderberg ◽  
C.R. Hansen ◽  
N. Høiby ◽  
S. Jensen-Fangel ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Early Treatment ◽  
Inhaled Antibiotics

scholarly journals An 8 week open-label interventional multicenter study to evaluate the lung clearance index as endpoint for clinical trials in cystic fibrosis patients ≥8 years of age, chronically infected with Pseudomonas aeruginosa

2020 ◽  
Author(s):  
Sivagurunathan Sutharsan ◽  
Susanne Naehrig ◽  
Uwe Mellies ◽  
Christian Sieder ◽  
joerg Zeigler
Keyword(s):  
Cystic Fibrosis ◽  
Pseudomonas Aeruginosa ◽  
Lung Function ◽  
Lung Disease ◽  
Small Airways ◽  
Open Label ◽  
Lung Clearance ◽  
Efficacy Trials ◽  
Inhaled Antibiotics ◽  
Lung Clearance Index

Abstract Background Forced expiratory volume in 1 second (FEV 1 ) is the only parameter currently recognized as a surrogate endpoint in cystic fibrosis (CF) trials. However, FEV 1 is relatively insensitive to changes in the small airways of patients with milder lung disease. This pilot study aimed to evaluate the lung clearance index (LCI) as a marker for use in efficacy trials with inhaled antibiotics in CF. Methods This open-label, single-arm study enrolled CF patients with Pseudomonas aeruginosa infection, who were treated with tobramycin (28-day on/off regime). FEV 1 , LCI and bacterial load in sputum (CFU) were assessed at baseline, after 1, 4 and 8 weeks of treatment. Results All patients (n=17) showed elevated LCI of >11 despite 3 patients having normal FEV 1 (>90% predicted) at baseline. Overall, LCI improved in 8 (47%) patients and FEV 1 in 9 (53%) patients. At week 4, LCI improved by 0.88, FEV 1 increased by 0.52%, and P. aeruginosa reduced by 30481.3 CFU/mL. These changes were however statistically non-significant. Six adverse events occurred in 5/17 (29.4%) patients, most of which were mild-to-moderate in severity. Conclusions Due to the low evaluable sample size, no specific trend was observed related to the changes between LCI, FEV1 and CFU. Based on the individual data from this study and from recently published literature, LCI has been shown to be a more sensitive parameter than FEV1 for lung function. LCI can hypothesized to be an appropriate endpoint for efficacy trials in CF patients if the heterogeneity in lung function is limited by enrolling younger patients or patients with more milder lung disease and thus, limiting the ventilation inhomogeneities. Trial registration : The study is registered with ClinicalTrials.gov, identifier: NCT02248922

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