Effect of Chronic Intermittent Administration of Inhaled Tobramycin on Respiratory Microbial Flora in Patients with Cystic Fibrosis

Pseudomonas aeruginosa endobronchial infection causes significant morbidity and mortality among cystic fibrosis patients. Microbiology results from two multicenter, double-blind, placebo-controlled trials of inhaled tobramycin in cystic fibrosis were monitored for longitudinal changes in sputum micr...

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Bibliographic Details
Published in:The Journal of infectious diseases 1999-05, Vol.179 (5), p.1190-1196
Main Authors: Burns, Jane L., Van Dalfsen, Jill M., Shawar, Ribhi M., Otto, Kelly L., Garber, Richard L., Quan, Joanne M., Montgomery, A. Bruce, Albers, Gary M., Ramsey, Bonnie W., Smith, Arnold L.
Format: Article
Language:English
Subjects:
Administration, Inhalation
Adolescent
Adult
Anti-Bacterial Agents - administration & dosage
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Antibacterial agents
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Aspergillus
Aspergillus - drug effects
Aspergillus - isolation & purification
Bacteria - drug effects
Bacteria - isolation & purification
Bacterial diseases
Bacterial sepsis
Biological and medical sciences
Candida albicans - drug effects
Candida albicans - isolation & purification
Child
Cystic fibrosis
Cystic Fibrosis - microbiology
Double-Blind Method
Drug Resistance, Microbial
Forced Expiratory Volume
Health care administration
Human bacterial diseases
Humans
Infections
Infectious diseases
Inhalation administration
Major Articles
Medical sciences
Microbial Sensitivity Tests
Microbiology
Pharmacology. Drug treatments
Placebos
Pseudomonas aeruginosa
Pseudomonas aeruginosa - drug effects
Pseudomonas Infections - drug therapy
Pseudomonas Infections - microbiology
Sputum
Sputum - microbiology
Tobramycin - administration & dosage
Tobramycin - pharmacology
Tobramycin - therapeutic use
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Description
Summary:Pseudomonas aeruginosa endobronchial infection causes significant morbidity and mortality among cystic fibrosis patients. Microbiology results from two multicenter, double-blind, placebo-controlled trials of inhaled tobramycin in cystic fibrosis were monitored for longitudinal changes in sputum microbial flora, antibiotic susceptibility, and selection of P. aeruginosa isolates with decreased tobramycin susceptibility. Clinical response was examined to determine whether current susceptibility standards are applicable to aerosolized administration. Treatment with inhaled tobramycin did not increase isolation of Burkholderia cepacia, Stenotrophomonas maltophilia, or Alcaligenes xylosoxidans; however, isolation of Candida albicans and Aspergillus species did increase. Although P. aeruginosa tobramycin susceptibility decreased in the tobramycin group compared with that in the placebo group, there was no evidence of selection for the most resistant isolates to become most prevalent. The definition of resistance for parenteral administration does not apply to inhaled tobramycin: too few patients had P. aeruginosa with a tobramycin MIC ⩾16 µg/mL to define a new break point on the basis of clinical response.
ISSN:0022-1899
1537-6613
DOI:10.1086/314727