Optimal airway antimicrobial therapy for cystic fibrosis: the role of inhaled aztreonam lysine.
BACKGROUND
Chronic endobronchial infection in cystic fibrosis (CF) leads to progressive lung function loss and respiratory failure. Most adult CF patients are infected with Pseudomonas aeruginosa, an important predictor of mortality. Suppressing chronic P. aeruginosa infection with inhaled antibiotics is standard of care for CF patients.


METHODS
This review describes the development (2003 - 2010) of aztreonam lysine 75 mg powder and solvent for nebulizer solution (AZLI; Cayston), an aerosolized formulation of the monobactam antibiotic aztreonam.


RESULTS
AZLI was studied in patients with CF and chronic P. aeruginosa airway infection. In placebo-controlled trials, AZLI improved respiratory symptoms, increased forced expiratory volume in 1 sec (FEV(1)), decreased sputum P. aeruginosa density, and was well tolerated. An open-label follow-on trial of nine 'on/off' courses showed that AZLI was safe and the effect durable with repeated administration. AZLI was recently approved for use in CF patients in Australia and the USA, and conditionally approved in Canada and the European Union. AZLI is given three times daily for 28 days (2 - 3 min/dose), followed by 28 days off-drug. AZLI is used only with the Altera Nebulizer System, which provides appropriate particle size and small airway deposition, and has excellent portability.


CONCLUSIONS
AZLI is a new therapy that is safe and effectively improves respiratory symptoms and FEV(1) in patients with CF.
Elborn
J Stuart
JS
Queen's University of Belfast, Centre for Infection and Immunity, Belfast, Northern Ireland, UK.
Henig
Noreen R
NR
D000280:Administration, Inhalation; D000336:Aerosols; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D001398:Aztreonam / Q000008:administration & dosage* / Q000493:pharmacokinetics; D018849:Controlled Clinical Trials as Topic; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D009330:Nebulizers and Vaporizers; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012129:Respiratory Function Tests; D016896:Treatment Outcome
D000336:Aerosols; D000900:Anti-Bacterial Agents; D001398:Aztreonam