From the Guidelines
Inhaled tobramycin and inhaled colistin are the primary agents used to treat Pseudomonas aeruginosa infections.
Treatment Options
- Inhaled tobramycin is strongly recommended for individuals with cystic fibrosis (CF) and moderate to severe lung disease with persistently present Pseudomonas aeruginosa in airway cultures, to improve lung function and quality of life, and reduce exacerbations 1.
- Inhaled colistin is recommended for patients with bronchiectasis and chronic Pseudomonas aeruginosa infection, as a first-line treatment option 1.
- Inhaled gentamicin may be considered as a second-line alternative to colistin for patients with bronchiectasis and chronic Pseudomonas aeruginosa infection 1.
Key Considerations
- The choice of antibiotic should be based on the resistance pattern of the microorganism and the patient's tolerance, allergies, and sensitivity 1.
- Patients should be counseled about potential major side effects with long-term antibiotics and monitored regularly for efficacy, toxicity, and continuing need 1.
- Prior to starting long-term inhaled aminoglycosides, patients should be assessed for safety reasons, including creatinine clearance and significant hearing loss or balance issues 1.
From the Research
Inhaled Agents for Pseudomonas Infections
The following inhaled agents are used to treat Pseudomonas aeruginosa infections:
- Tobramycin 2, 3, 4
- Aztreonam 2, 3, 4
- Levofloxacin 2, 3, 5, 6
- Colistin 2, 3, 4
- Liposomal amikacin 2
- Murepavadin 2
- Ceftazidime 5
- Vancomycin 5
- Ciprofloxacin 5
- Fosfomycin and tobramycin combination 5
Mechanism of Action and Efficacy
These inhaled agents work by targeting Pseudomonas aeruginosa and reducing its density in the sputum, thereby improving lung function and reducing the frequency of exacerbations 3, 4, 6. The choice of inhaled antibiotic depends on various factors, including the patient's characteristics, the features of the drug, and the inhalation system 4.
Safety and Tolerability
The safety and tolerability of these inhaled agents have been evaluated in several studies, with most showing comparable study withdrawal rates among the different inhaled antibiotics 3, 4. However, the currently available data are heterogeneous, and no safe conclusion regarding the effectiveness and safety of these drugs can be reached 5.