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Cystic fibrosis infection and biofilm busters
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
Jennifer Fiegel, Sachin Gharse
Current treatment strategies against established pulmonary bacterial infections effectively slow down the progression of infections and improve the quality of life for CF patients (3). Chronic airway infections are treated using suppressive antibiotic therapy in order to maintain lung function. Approved antibiotics for the inhalation treatment of respiratory infections in CF patients, including tobramycin, aztreonam, and colistimethate sodium. Tobramycin inhalation solutions (such as TOBI®, TIS®, Kitabis Pak®, and Bethkis®) and tobramycin inhalation powder (TOBI Podhaler™), are currently available for management of chronic P. aeruginosa infections (28). Nebulized monobactam aztreonam lysine inhalation solution (Cayston®) is a safe and efficacious formulation against chronic P. aeruginosa infections in CF patients (28). Clinical studies carried out to compare the efficacies of Cayston and TIS in CF patients demonstrated superiority of Cayston over TIS in improving lung function, reducing pulmonary exacerbations, and aiding patient weight gain (32–34). An open-label study of aztreonam lysine inhalation solution showed similar success rates in eradicating P. aeruginosa as those reported for other antibiotic regimens (35). Cayston is available in the United States, Canada, Switzerland, and the European Union (28). Typically patients age 7 and over alternate between 28-day treatments of tobramycin and aztreonam.
Aztreonam and Aztreonam-Avibactam
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Aztreonam is usually administered by the parenteral route. However, inhaled aztreonam solution is currently available for the treatment of patients with cystic fibrosis (CF). A lysine salt formulation of aztreonam was developed for inhalation because intravenous aztreonam formulation contains arginine, which has been shown to cause airway inflammation after chronic inhalation therapy in patients with CF (Dietzsch et al., 1975; Gibson et al., 2006). For this therapy, aztreonam lysine is usually administered in a regimen of 75 mg three times daily by nebulizer (Waters and Smyth, 2015).
Current and future pharmacotherapy options for non-cystic fibrosis bronchiectasis
Published in Expert Review of Respiratory Medicine, 2018
Rodrigo Athanazio, Joao Cordeiro da Costa, David de la Rosa Carrillo, Miguel Ángel Martínez-García
The intravenous formulation of gentamicin has also been tested in bronchiectasis patients colonized by various pathogenic microorganisms, with not only some clinical improvements but also bronchospasm in 21% of these patients [55]. The administration of aztreonam lysine failed to demonstrate any efficacy with respect to the primary end point of quality of life, apart from a reduction in the sputum bacterial load; furthermore, many patients suffered frequent adverse events that led them to withdraw from the study [56]. We can therefore conclude that the favorable results obtained in CF patients have not all been validated yet for bronchiectasis. There may be several reasons for these disappointing findings, including scarcity of studies, short-term design, small and heterogeneous samples and inadequate primary outcomes.
Gram negative infections in cystic fibrosis: a review of preventative and treatment options
Published in Expert Opinion on Orphan Drugs, 2020
Charlotte Addy, Steven Caskey, Damian Downey
The efficacy of chronic suppressive therapy for Bcc may vary by genomovar. With 21 genomovars, and limited studies examining suppressive therapy for Bcc it is not possible to stratify response [12]. One randomized study in PWCF ≥6 years, with chronic growth of Bcc, compared 24 weeks of nebulized Aztreonam lysine to placebo, followed by 24 weeks open-label treatment. While there was no evidence of a significant increase in ppFEV1 compared to placebo, or during the open-label treatment period, there was a trend toward a reduction in PEx and hospital admission [72]. Specific genomovars, including B. multivorans may show sensitivity to oral agents, particularly tetracycline’s, but the efficacy of long-term oral suppressive therapy is unknown [15].