In this episode, I’ll discuss nebulized tobramycin for bronchiectasis from pseuduomonas.
Bronchiectasis is a chronic airway infection with exacerbations that can cause increases in sputum production/purulence, cough, hemoptysis, respiratory distress, and fatigue. The focus of treatment for an exacerbation is usually on the reduction of bacterial load which then leads to the amelioration of symptoms.
Patients with bronchiectasis from Pseudomonas are at high risk of exacerbation. Treatment of this condition is typically done with IV or oral antibiotics. Nebulized tobramycin has been studied for this condition however the degree of clinical benefit was not impressive.
A recent Double-blind Randomized Placebo-controlled Phase-3 Trial of Tobramycin Inhalation Solution in Adults with Bronchiectasis with Pseudomonas aeruginosa Infection has been published in the journal Chest.
The investigators split almost 350 patients between a treatment and placebo group in order to determine whether inhaled tobramycin can effectively reduce sputum Pseudomonas aeruginosa density and improve the bronchiectasis-specific quality-of-life in bronchiectasis patients with Pseudomonas aeruginosa infection.
The treatment group received nebulized tobramycin 300 mg/5 mL twice daily and the placebo group received normal saline 5 mL twice daily via a vibrating-mesh nebulizer.
The authors found that compared with placebo, the nebulized tobramycin group had a significantly greater reduction in P. aeruginosa density and greater improvement in Quality-of-life-Bronchiectasis Respiratory Symptom Score at day 29. These findings held at day 85 as well.
Additional benefits of nebulized tobramycin included a significant reduction in 24-hour sputum volume and sputum purulence score at days 29, 57 and 85, as well as almost 3 times more patients that became culture negative for P. aeruginosa vs placebo group at day 29.
The incidence of adverse events and serious adverse events were comparable between the two groups.
Based on these findings the authors concluded that nebulized tobramycin is an effective treatment option and has an acceptable safety profile in bronchiectasis patients with P. aeruginosa infection.
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To access my free download area with 20 different resources to help you in your practice, go to pharmacyjoe.com/free.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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