Long-term safety and efficacy of tobramycin in the management of cystic fibrosis

Abstract

Emma Vázquez-Espinosa, Rosa María Girón, Rosa Mar Gómez-Punter, Elena García-Castillo, Claudia Valenzuela, Carolina Cisneros, Enrique Zamora, F Javier García-Pérez, Julio AncocheaPulmonology Department, La Princesa Institute for Health Research, Hospital Universitario de La Princesa, Madrid, SpainAbstract: Cystic fibrosis (CF) is a fatal inherited disease caused by mutations in the CF transmembrane conductance regulator (CFTR) gene whose mortality is conditioned by a progressive decline in lung function. Bacterial infections play a key role in this decline. Chronic bacterial infection in CF patients varies over time and the presence of Pseudomonas aeruginosa in sputum is a marker of poor prognosis. P. aeruginosa is eradicated from the airways using inhaled antibiotics administered in various formulations and devices. Antipseudomonal antibiotics have extended the survival of CF patients to 40 years. Tobramycin is a bactericidal aminoglycoside antibiotic with demonstrated activity against gram-negative microorganisms. Initially, the drug was administered as an inhaled parenteral solution. Subsequently, a specific tobramycin inhalation solution was developed. PulmoSphere™ technology enables dry tobramycin powder to be formulated for inhalation (tobramycin inhalation powder) using a small and portable capsule-based breath-activated device (T-326). Chronic colonization by P. aeruginosa is the main indication for aerosol antibiotic therapy. The American Cystic Fibrosis Foundation, European guidelines, and Spanish consensus guidelines provide different recommendations for eradication.Keywords: cystic fibrosis, Pseudomonas aeruginosa, tobramycin, chronic infection, inhaled antibiotic