No prospective study has assessed eradication treatment of early Pseudomonas aeruginosa ( P. aeruginosa ) colonisation in bronchiectasis not due to cystic fibrosis.
Researchers have evaluated the efficacy of 3 months of nebulised Tobramycin after a short course of intravenous antibiotics in the eradication of Pseudomonas aeruginosa and its clinical consequences in non-cystic fibrosis bronchiectasis following initial Pseudomonas aeruginosa infection.
A 15-month, single-masked, randomised study including 35 patients was conducted in a tertiary university hospital. Following the isolation of Pseudomonas aeruginosa and a 14-day intravenous treatment with Ceftazidime and Tobramycin, patients received 300 mg nebulised Tobramycin twice daily or placebo during 3 months, and were followed up for 12 months thereafter.
The median time to recurrence of Pseudomonas aeruginosa infection was higher in the Tobramycin than in the placebo group ( p = 0.048, log-rank test ).
At the end of the study 54.5% of the patients were free of Pseudomonas aeruginosa in the Tobramycin group and 29.4% in the placebo group.
The numbers of exacerbations ( p=0.044 ), hospital admissions ( p=0.037 ) and days of hospitalisation ( p=0.034 ) were lower in the Tobramycin than in the placebo group.
A global, non-significant trend to improvement in the Tobramycin group was observed in most of the other studied parameters on comparing the two groups.
Bronchospasm in the Tobramycin group was remarkable.
In conclusion, the study has shown that 3 months of nebulised Tobramycin following a short course of intravenous antibiotics may prevent bronchial infection with Pseudomonas aeruginosa and has a favourable clinical impact on non-cystic fibrosis bronchiectasis. ( Xagena )
Orriols R et al, Respiration 2015; Epub ahead of print