A network meta-analysis of the efficacy of inhaled antibiotics for chronic Pseudomonas infections in cystic fibrosis.
BACKGROUND
Various inhaled antibiotics are currently used for treating chronic Pseudomonas aeruginosa lung infection in cystic fibrosis (CF) patients, however their relative efficacies are unclear. We compared the efficacy of the inhaled antibiotics tobramycin (TIP, TIS-T, TIS-B), colistimethate sodium (colistin) and aztreonam lysine for inhalation (AZLI) based on data from randomised controlled trials.


METHODS
In the base case, efficacies of antibiotics were compared using a network meta-analysis of seven trials including change from baseline in forced expiratory volume in 1 second (FEV(1)) % predicted, P. aeruginosa sputum density and acute exacerbations.


RESULTS
The tobramycin preparations, AZLI and colistin, showed comparable improvements in efficacy in terms of FEV1% predicted at 4 weeks; the difference in % change from baseline (95%CrI) for TIP was compared to TIS-T (-0.55, -3.5;2.4), TIS-B (-0.64, -7.1;5.7), AZLI (3.64, -1.0;8.3) and colistin (5.77, -1.2;12.8).


CONCLUSIONS
We conclude that all studied antibiotics have comparable efficacies for the treatment of chronic P. aeruginosa lung infection in CF.
Mapi Consultancy, De Molen 84, 3995 AX Houten, The Netherlands. klittlewood@mapigroup.com
Kavi J
KJ
Littlewood
Kyoko
K
Higashi
Jeroen P
JP
Jansen
Gorana
G
Capkun-Niggli
Maria-Magdalena
MM
Balp
Gerd
G
Doering
Harm A W M
HA
Tiddens
Gerhild
G
Angyalosi
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000493:pharmacokinetics; D001398:Aztreonam / Q000008:administration & dosage / Q000493:pharmacokinetics; D058491:Bacterial Load / Q000187:drug effects; D001499:Bayes Theorem; D001682:Biological Availability; D002908:Chronic Disease; D003091:Colistin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D003550:Cystic Fibrosis / Q000150:complications / Q000175:diagnosis; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007255:Information Services; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000302:isolation & purification; D016032:Randomized Controlled Trials as Topic; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000382:microbiology; D014031:Tobramycin / Q000008:administration & dosage / Q000493:pharmacokinetics; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; C004691:colistinmethanesulfonic acid; D001398:Aztreonam; D014031:Tobramycin; D003091:Colistin