International Journal of COPD (Oct 2019)
Nebulized Colistin And Continuous Cyclic Azithromycin In Severe COPD Patients With Chronic Bronchial Infection Due To Pseudomonas aeruginosa: A Retrospective Cohort Study
Abstract
Concepción Montón,1,2 Elena Prina,1 Xavier Pomares,1,3 Jose R Cugat,4 Antonio Casabella,5 Joan Carles Oliva,6 Miguel Gallego,1,3 Eduard Monsó1,3 1Department of Respiratory Medicine, Hospital De Sabadell, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; 2Health Services Research on Chronic Diseases Network-REDISSEC, Galdakao, Spain; 3CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain; 4Department of Respiratory Medicine, Fundació Althaia, Manresa, Spain; 5Laboratory of Microbiology-UDIAT, Institut Universitari Parc Taulí-UAB, Sabadell, Spain; 6Epidemiology and Assessment Unit, Fundació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, SpainCorrespondence: Concepción MontónDepartment of Respiratory Medicine, Hospital de Sabadell, Institut Universitari Parc Tauli-UAB, Parc Taulí 1, Sabadell, Barcelona 08208, SpainTel +34 93 7458262Email [email protected]: Long-term use of nebulized or oral antibiotics is common in the treatment of cystic fibrosis and non-cystic fibrosis bronchiectasis. To date, however, few studies have focused on the use of nebulized antibiotics in COPD patients. The aims of this study are: to establish whether a combination of nebulized colistin plus continuous cyclic azithromycin in severe COPD patients with chronic bronchial infection due to Pseudomonas aeruginosa reduces the frequency of exacerbations, and to assess the effect of this treatment on microbiological sputum isolates.Material and methods: A retrospective cohort was created for the analysis of patients with severe COPD and chronic bronchial infection due to P. aeruginosa treated with nebulized colistin at the Respiratory Day Care Unit between 2005 and 2015. The number and characteristics of COPD exacerbations (ECOPD) before and up to two years after the introduction of nebulized colistin treatment were recorded.Results: We analyzed 32 severe COPD patients who received nebulized colistin for at least three months (median 17 months [IQR 7–24]). All patients but one received combination therapy with continuous cyclic azithromycin (median 24 months [IQR 11–30]). A significant reduction in the number of ECOPD from baseline of 38.3% at two years of follow-up was observed, with a clear decrease in P. aeruginosa ECOPD (from 59.5% to 24.6%) and a P. aeruginosa eradication rate of 28% over the two-year follow-up.Conclusion: In patients with severe COPD and chronic bronchial infection due to P. aeruginosa, combination therapy with nebulized colistin and continuous cyclic azithromycin significantly reduced the number of ECOPD, with a marked decrease in P. aeruginosa sputum isolates.Keywords: COPD, exacerbation, azithromycin, colistin, Pseudomonas aeruginosa
