Eradication treatment in Non CF bronchiectasis: The effect of inhaled antibiotics (tobramycin and colistin) on patients with pseudomonas aeruginosa
Introduction: There is limited information on the eradication treatment in non CF Bronchiectasis (NCFB) patients with Pseudomonas aeruginosa (Pa) in sputum.
Aim: To evaluate the effect of inhaled tobramycin and colistin on eradication of Pa in patients with NCFB.
Methods: Fifty two patients were studied (33 women), mean age58.6+15.2 years, with >104 CFU of Pa/ ml in sputum culture. All patients received ciprofloxacin 750 mg bid for 14 days. They were then randomized in 3 groups and received: Tobramycin (Tobi, Novartis) 300mgx2 (group A, n=17), Colistimethate sodium (Colistin, Norma) 1MUx2 (group B, n=18), placebo N/S 0.9% 4ccx2 (group C, n=17). Administration was done through Pari LC Plus jet nebulizer for 3 months. Sputum culture, volume and purulence, dyspnea, spirometry and SaO2 were estimated before and after treatment.
Results: In groups A and B a significant reduction in Pa density as well as in sputum volume was found compared to placebo (mean Δlog10 CFUs=2.1 vs 1.1 and 2.7 vs 1.1, p<0.001 and mean Δvolume (ml)= 11.2 vs 2.2 and 11.4 vs 2.2, p<0.0001 respectively).Eradication was observed in 47%, 39% and 17.6% of patients in groups A, B and C respectively. Improvement in sputum purulence was also found in group A and B compared to placebo (Mean Δ+ SD= -1.3+0.8vs-0.5+0.6, p=0.0026 and -1.1+1vs -0.5+0.6, p= 0.03 respectively).Differences in MRC scale , spirometry and SaO2 were not significant.
Conclusion: Our findings indicate that inhaled antibiotics, tobramycin and colistin, may be effective in eradicating Pa, reducing bacterial load and improving symptoms of bronchiectatic patients. Further investigation is required.