Inhaled antibiotic therapy in non-cystic fibrosis patients with bronchiectasis and chronic bronchial infection by Pseudomonas aeruginosa

The aim of this study was to investigate the long-term effectiveness and sa fety of inhaled antibiotic treatment in non-cystic fibrosis patients with b ronchiectasis and chronic infection by Pseudomonas aeruginosa, after standa rd endovenous and oral therapy for long-term control of the infection had f ailed. After completing a 2-week endovenous antibiotic treatment to stabili ze respiratory status, 17 patients were randomly allocated to a 12-month tr eatment either with inhaled ceftazidime and tobramycin (group A) or a sympt omatic treatment (group B). One patient from group A abandoned inhaled trea tment because of bronchospasm and another from group B died before the end of the study. The remaining 15 patients, seven from group A and eight from group B, completed the study. Both groups had similar previous characterist ics. The number of admissions and days of admission (mean +/- SEM) Of group A [0.6 (1.5) and 13.1 (34.8)] were lower than those of group B [2.5 (2.1) and 57.9 (41.8)] (P<0.05). Forced vital capacity (FVC), forced expiratory v olume in I sec (FEV1), PaO2 and PACO(2) were similar in the two groups at t he end of follow-up, showing a comparable decline in these parameters. Ther e were no significant differences either in the use of oral antibiotics or in the frequency of emergence of antibiotic-resistant bacteria between grou ps. Microbiological studies suggested that several patients had different P seudomonas aeruginosa strains. None of the patients presented impaired rena l or auditory function at the end of the study. This study suggests that lo ng-term inhaled antibiotic therapy may be safe and lessen disease severity in non-cystic fibrosis patients with bronchiectasis and chronic bronchial i nfection by Pseudomonas aeruginosa which do not respond satisfactorily to a ntibiotics administered via other routes.