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


Journal Article

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.

Full Text

Cited Authors

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

Published Date

  • March 2010

Published In

Volume / Issue

  • 45 / 3

Start / End Page

  • 281 - 290

PubMed ID

  • 20146365

Pubmed Central ID

  • 20146365

Electronic International Standard Serial Number (EISSN)

  • 1099-0496

International Standard Serial Number (ISSN)

  • 8755-6863

Digital Object Identifier (DOI)

  • 10.1002/ppul.21176


  • eng