INHALED ANTIBIOTICS IN CYSTIC-FIBROSIS - A REVIEW

OBJECTIVE: To provide an overview of aerosol drug therapy, including p hysical considerations and aerosol drug delivery systems, and to revie w clinical experience with inhaled antibiotics in cystic fibrosis (CF) when used as adjunctive therapy to intravenous therapy for acute pulm onary exacerbations and chronic, suppressive therapy. DATA SOURCES: A MEDLINE search (1966-1995) of English-language literature describing t he use of inhaled antibiotics for the management of CF. STUDY SELECTIO N AND DATA EXTRACTION: All articles were considered for possible inclu sion in the review. pertinent information as judged by the authors was selected for discussion. DATA SYNTHESIS: The use of inhaled antibioti cs as adjunctive therapy to systemic therapy for acute exacerbations d id not improve pulmonary function tests, increase hospital discharge r ate, or permanently eradicate sputum Pseudomonas. Clinical trials of i nhaled antibiotics as suppressive therapy yielded variable results. In dividually, four trials documented a significant improvement in pulmon ary function, three trials documented a slower decline in pulmonary fu nction, and four trials reported a reduced frequency of hospitalizatio ns. However, the trials were unable to collectively document a prolong ed beneficial effect of inhaled antibiotics on pulmonary function, spu tum bacterial density, and frequency of hospitalizations. CONCLUSIONS: Clinical trials conducted thus far suggest no role for inhaled antibi otics in the treatment of acute pulmonary exacerbations in patients wi th CF. Aerosolized antibiotics used as suppressive therapy may be usef ul in certain patients, but their use should be limited to select pati ents based on individual response to therapy. Additional long-term, we ll-controlled trials of inhaled antibiotics as suppressive therapy are needed before routine use can be recommended.