Introduction: Clinical studies evaluating the rational use of the combination of intravenous and aerosolized antibiotics (AB) in acute lung exacerbations are scarce and conclude that this combination therapy is not superior compared to intravenously administered therapy alone. The aim: compare 3 combinations of AB regimes against Pseudomonas aeruginosa (Pa) in cystic fibrosis (CF) patients with lung exacerbation. Methods: 108 CF patients (pts) with chronic Pa were prospectively randomized to 14 days of different AB courses: Group A - 32 pts (4-16 yrs) treated with TOBI (16 pts) or Bramitob (16 pts), 300mg bid in combination with i.v. ceftazidime and oral ciprofloxacin; Group B - 39 pts (6-17yrs) treated with i.v. cefepime and i.v. amikacin; Group C - 37 pts (4-17yrs) treated with i.v. meropenem and i.v. amikacin. Results: All AB combinations significantly improved clinical symptoms, lung function and reduced sputum Pa density. Improvement of FVC in A, B and C groups was +27.98%, +24.27% and +31.44%, respectively. Increase of FEV1 was + 37.17%, +28.85% and +40.6%, respectively. A group with inhaled tobramycins was significantly superior in decrease of Pa sputum density and even eradication after treatment. In group A there was no growth of Pa sm. in 77.3% of patients, in group B - 45.5%, in group C - 26%. Pa muc. completely disappeared from sputum in group A in 79% of children, in group B - 25.8% and in group C - 29.1%. Conclusion: Combination of inhaled form of tobramycin with oral ciprofloxacin and i.v. ceftazidime for treatment of acute exacerbation in CF pts with chronic Pa infection was superior compared to standard i.v. administered therapy.
Semykin, S. Y., Polikarpova, S. V., Dubovik, L. G., & Kashirskaya, N. Y. (2010). Efficiency of the inhalational tobramycin therapy in complex antibacterial therapy of lung exacerbation in cystic fibrosis children with chronic Pseudomonas aeruginosa infection. Journal of Cystic Fibrosis, 9, S55. https://doi.org/10.1016/s1569-1993(10)60215-9