Inhaled versus systemic antibiotics and airway inflammation in children with cystic fibrosis and Pseudomonas.

Academic Article

Abstract

  • RATIONALE: Inhaled tobramycin has been shown to transiently clear Pseudomonas from lower airways in early cystic fibrosis (CF), but does not markedly reduce lung inflammation, a key factor in disease progression. OBJECTIVE: Test the hypothesis that systemic antibiotics are more effective than inhaled antibiotics for reducing lower airways inflammation. METHODS: Clinically stable CF children with recent Pseudomonas were randomized to receive 4 weeks of inhaled tobramycin or 2 weeks of systemic antibiotics (intravenous ceftazidime and tobramycin). Bronchoalveolar lavage fluid was obtained just before and 4-6 weeks after treatment. The primary outcome was change in % neutrophils in lavage fluid. RESULTS: Fifteen subjects (inhaled = 6, systemic = 9) completed the protocol. Three Systemic Group subjects could not have central venous access established and were treated with oral ciprofloxacin (plus inhaled tobramycin) for 2 weeks as an alternative "systemic" regimen, per protocol. Groups were well matched in age, markers of disease severity, and initial % neutrophils. The Systemic Group showed a modest median change in percent neutrophils (-7%) which was not statistically significant compared to inhaled (+5.4%, P = 0.07). However, the Systemic Group had significantly greater reductions in total cells (-50% vs. -3%, P < 0.01) and neutrophils (-74% vs. -10%, P = 0.02) per ml lavage fluid. Both groups had reduced bacterial quantity after treatment, but there was no significant difference between groups. CONCLUSIONS: In clinically stable children with CF, systemic antibiotics result in greater short-term reduction in lower airways inflammation than inhaled antibiotics.
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    Keywords

  • Administration, Inhalation, Anti-Bacterial Agents, Bronchoalveolar Lavage Fluid, Child, Child, Preschool, Cystic Fibrosis, Female, Humans, Infant, Infusions, Intravenous, Male, Pneumonia, Bacterial, Pseudomonas Infections
  • Digital Object Identifier (doi)

    Author List

  • Noah TL; Ivins SS; Abode KA; Stewart PW; Michelson PH; Harris WT; Henry MM; Leigh MW
  • Start Page

  • 281
  • End Page

  • 290
  • Volume

  • 45
  • Issue

  • 3