1887
  1. Home
  2. A-Z Publications
  3. Qatar Medical Journal
  4. Volume 2006, Issue 1
  5. Article
Volume 2006, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Once daily tobramycin is convenient to use and achieves higher tissue levels that should kill Pseudomonas aeruginosa more rapidly. Small trials of OD compared with TDS aminoglycosides in CF patients have shown no dif-ference in efficacy or toxicity. No one has looked in detail at the impact on sputum microbiology. In a prospective, randomized study at Papworth Hospital, UK, we compared OD with TDS tobramycin, each plus a second anti-pseudomonal, for the treatment of acute infective exacer-bation in 15 adult cystic fibrosis patients colonized with Pseudomonas aeruginosa. Using the patients as their own control, the same individuals received the alternate treat-ment regime for the next exacerbation. We aimed to com-pare the clinical and bacteriological efficacy, toxicity>, and the effects on susceptibility of the organism among patients in both treatment groups. Isolates were identified, and the Minimum Inhibitory Concentration (MIC) of the antibi-otic in each patient was performed. Patients were assessed for clinical improvement, toxicity and the total viable count in their sputum on days 0\ 7 and 14. In both treatment groups there was a significant clinical improvement, and toxicity did not occur in either group. There was no differ-ence in clinical outcome, adverse events, or time to the next exacerbation. No difference was seen in the selection of antibiotic resistance. OD tobramycin appeared more ef-fective in reducing the number of bacteria in the group overall at day 7 and in two individuals, at day 14.

© 2006 Al Ansari, Foweraker, Mackeown, Bilton, licensee Bloomsbury Qatar Foundation Journals.
Loading

Article metrics loading...

/content/journals/10.5339/qmj.2006.1.13
2006-06-01
2024-04-19
Loading full text...

Full text loading...

References

  1.  Clinical standards advisory group: Cystic fibrosis, access to and availability of specialist services. London: HMSO March1993.
     [Google Scholar]
  2. Schidlow DV, Taussig LM, Knowles MR. Cystic Fibrosis Foundation Consensus Conference Report on pulmonary complications of cystic fibrosis. Pediatric Pulmonology. 1993; 15::187–198.
     [Google Scholar]
  3. Fitz Simmons SC. The changing epidemiology of cystic fibrosis. The Journal of Pediatrics. 1993; 122::1–9.
     [Google Scholar]
  4. Friend PA. Pulmonary infection in cystic fibrosis. Journal of Infection. 1986; 13::55–72.
     [Google Scholar]
  5. Zabner R, Quinn JP. Antimicrobials in cystic fibrosis: Emer-gence of resistance and implications for treatment. [Review] [44 refs] Seminars in Respiratory Infections. 1992 Sep; 7:3:210–217.
     [Google Scholar]
  6. Powell SH, Thompson WL, Luthe MA, Stern RC, Grossniklaus DA, Bloxham DD, Groden DL, Jacobs MR, DiScenna AO, Cash HA, Klinger JD. Related Articles Once-daily vs. continuous aminoglycoside dosing: efficacy and toxicity in animal and clinical studies of gentamicin, netilmicin, and tobramycin. Journal of Infectious Diseases. 1983 May; 147:5:918–932.
     [Google Scholar]
  7. Bates RD, Nahata MC, Jones JW, McCoy K, Young G, Cox S, Barson WJ. Pharmacokinetics and safety of tobramycin after once-daily administration in patients with cystic fibrosis. Chest. 1997; 112:5:1208–1213, Nov 5.
     [Google Scholar]
  8. Canis F, Husson MO, Turck D, Vic P, Launay V, Ategbo S, Vincent A, Courcol RJ. Pharmacokinetics and bronchial diffusion of single daily dose amikacin in cystic fibrosis patients. Journal of Antimicrobial and Chemotherapy. 1997 Mar; 39:3:431–433.
     [Google Scholar]
  9. Master V, Roberts GW, Coulthard KP. Efficacy of once-daily tobramycin monotherapy for acute pulmonary exacerbations of cystic fibrosis: A prelimi-nary study. Pediatric Pulmonology. 2001; 31::367–376.
     [Google Scholar]
  10. Vic P, Ategbo S, Turck D. Related Articles Efficacy, tolerance, and pharmacokinetics of once daily tobramycin for pseudomonas exacerbations in cystic fibrosis. Archives of Disease in Childhood. 1998; 78::536–539.
     [Google Scholar]
  11. Karlowsky JA, Zhanel GG, Davidson RJ, Hoban DJ. Once-daily aminoglycoside dosing assessed by MIC reversion time with Pseudomonas aeruginosa. Antimicrobial Agents and Chemotherapy. 1994; 38::1165–1168.
     [Google Scholar]
  12. MacArthur RD, Lolans V, Zar FA, Jackson GG. Biphasic, concentration-dependent and rate-limited, concentration independent bacterial killing by an aminoglycoside antibiotic. Journal of Infectious Diseases. 1984; 150::778–779.
     [Google Scholar]
  13. Vogelman B, Gudmundsson S, Turnidge J, Leggett J, Craig WA. In vivo postantibiotic effect in a thigh infection in neutro-penic mice. Journal of Infectious Diseases. 1988; 157::287–298.
     [Google Scholar]
  14. Gibson J, Johnson L, Snowden L, Joshua D, Young G, MacLeod C, et al., Single daily ceftriaxone and tobramcyin in the empirical management of febrile neutropenic patients: A randomised trial. International Journal of Hematology. 1993; 58::63–72, Infectious Diseases 21, 1406-10.
     [Google Scholar]
  15. Bourget P, Fernandez H, Delouis C, Taburet AM. Pharma-cokinetics of tobramycin in pregnant women. Safety and efficacy of a once-daily dose regimen. Journal of Clinical Pharmacy and Therapeutics. 1991; 16::167–176.
     [Google Scholar]
  16. Nicolau DP, Freeman CD, Belliveau PP, Nightingale CH, Ross JW, Quintiliani R. Experience with a once-daily aminoglycoside program administered to 2,184 adult patients. Antimicrobial Agents & Chemotherapy. 1995; 39::650–655.
     [Google Scholar]
  17. Tan K. Bunn H. Once daily versus multiple daily dosing with intravenous aminoglycosides for cystic fibrosis. Cochrane Database of Systematic Reviews (4), 2000.
  18. Martin AJ, Smalley CA, George RH, et al., Gentamicin and tobramycin compared in the treatment of mucoid pseudomonas lung infections in cystic fibrosis. Archives of Disease in Childhood. 1980; 55::604–607.
     [Google Scholar]
  19. Regelmann WE, Elliott GR, Warwick WJ, Clawson CC. Reduction of sputum Pseudomonas aeruginosa density by antibiotics improves lung function in cystic fibrosis more than do bronchodilators and chest physiotherapy alone. American Review of Respiratory Disease. 1990 Apr; 141:4 Pt 1:914–921.
     [Google Scholar]
  20. Wolter JM, Bowler SD, McCormack JG. Are antipseudomonal antibiotics really beneficial in acute respiratory exacerbations of cystic fibrosis? Australian & New Zealand Journal of Medicine. 1999 Feb; 29:1:15–21.
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/qmj.2006.1.13
Loading
  • Article Type: Research Article
Keyword(s): Cystic Fibrosis, Pseudomonas aeruginosa and Tobramycin

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error