title: Inhaled antibiotics for long-term therapy in cystic fibrosis.
abstract: BACKGROUND
  Inhaled antibiotics are commonly used to treat persistent airway infection that contributes to lung damage in people with cystic fibrosis (CF).
  
  
  OBJECTIVE
  To examine the evidence that inhaled antibiotic treatment in people with CF reduces frequency of exacerbations of infection, and improves lung function, quality of life and survival. To examine adverse effects of inhaled antibiotic treatment.
  
  
  METHODS
  Trials were identified from the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register.Last search: 31 January 2011.
  
  
  METHODS
  Trials were selected if inhaled antibiotic treatment was used for at least four weeks in people with CF, treatment allocation was randomised or quasi-randomised, and there was a control group (either placebo, no placebo or another inhaled antibiotic).
  
  
  METHODS
  Two authors independently selected trials, judged the risk of bias and extracted data from these trials.
  
  
  RESULTS
  The searches identified 176 citations to 78 trials. Nineteen trials, with 1724 participants, met the inclusion criteria. Adequate meta-analysis was not possible because of the variability of study design and reporting of results. Seventeen trials with 1562 participants compared an inhaled antibiotic with placebo or usual treatment for a duration between 1 and 32 months. Inhaled tobramycin was studied in eight trials. Lung function (measured as forced expired volume in one second) was higher and exacerbations of lung infection (by different measures) were less in the antibiotic-treated group. Resistance to antibiotics increased more in the antibiotic-treated group than in placebo group when results were reported. No auditory or renal impairment was found; analysis showed tinnitus, voice alteration, hemoptysis and cough were more frequent with tobramycin than placebo. One trial, compared tobramycin with colistin in 115 participants, after one month the mean difference in forced expiratory volume at one second was 6.33 (95% confidence interval -0.04 to 12.70) favouring tobramycin.
  
  
  CONCLUSIONS
  Inhaled antibiotic treatment probably improves lung function and reduces exacerbation rate, but a pooled estimate of the level of benefit is not possible. The best evidence is for inhaled tobramycin. More evidence, from trials of longer duration, is needed to determine whether this benefit is maintained and to determine the significance of development of antibiotic-resistant organisms.
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Ground Floor B Block, Verdun Street, Nedlands, Western Australia 6009, Australia.
authors.forename: Gerard
authors.initials: G
authors.lastname: Ryan
authors.forename: Meenu
authors.initials: M
authors.lastname: Singh
authors.forename: Kerry
authors.initials: K
authors.lastname: Dwan
mesh_terms: D000280:Administration, Inhalation; D000281:Administration, Intranasal; D000336:Aerosols; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003550:Cystic Fibrosis / Q000150:complications*; D006801:Humans; D009330:Nebulizers and Vaporizers; D011552:Pseudomonas Infections / Q000209:etiology / Q000517:prevention & control*; D011550:Pseudomonas aeruginosa; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000336:Aerosols; D000900:Anti-Bacterial Agents