title: Inhaled antibiotics for the treatment of chronic bronchopulmonary Pseudomonas aeruginosa infection in cystic fibrosis: systematic review of randomised controlled trials.
abstract: BACKGROUND
  Inhaled antibiotics are probably the safest and most effective therapy for Pseudomonas aeruginosa chronic lung infection in cystic fibrosis (CF) patients.
  
  
  METHODS
  To summarise the available evidence, a systematic review of the three currently available inhaled antibiotics (aztreonam lysine (AZLI), colistin (COL) and tobramycin (TOB)) was performed. The three AZLI placebo-controlled studies showed that the improvements in FEV1 and mean sputum P. aeruginosa density were statistically significant better than with placebo. The two COL placebo-controlled studies involved few patients but showed that COL was better than placebo in terms of maintenance of some pulmonary function parameters. The tobramycin inhalation solution (TIS) and tobramycin inhalation powder studies showed that the efficacy of both formulations was similar but significantly better than placebo. In the comparative studies, TIS showed more efficacy than COL solution, colistin inhalation powder showed non-inferiority to TIS and AZLI was superior to TIS.
  
  
  CONCLUSIONS
  Placebo-controlled and comparative clinical trials have shown that clinical evidence of inhaled antibiotics is very different. The choice of treatment for each individual CF patient must be based on the features of the drug (clinical evidence on efficacy and safety), the inhalation system and the patient characteristics. Development of new inhaled antibiotics will allow new end points of efficacy and therapy regimens to be assessed.
authors.affiliation: Ramón y Cajal University Hospital, Unit of Bronchiestasis and Cystic Fibrosis, Respiratory Department , Madrid , Spain lmaiz.hrc@salud.madrid.org.
authors.forename: Luis
authors.initials: L
authors.lastname: Máiz
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Girón
authors.forename: Casilda
authors.initials: C
authors.lastname: Olveira
authors.forename: Esther
authors.initials: E
authors.lastname: Quintana
authors.forename: Adelaida
authors.initials: A
authors.lastname: Lamas
authors.forename: Dolores
authors.initials: D
authors.lastname: Pastor
authors.forename: Rafael
authors.initials: R
authors.lastname: Cantón
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
mesh_terms: D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001398:Aztreonam / Q000008:administration & dosage / Q000627:therapeutic use; D002908:Chronic Disease; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use; D003550:Cystic Fibrosis / Q000150:complications*; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy / Q000382:microbiology; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D016032:Randomized Controlled Trials as Topic; D014031:Tobramycin / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D001398:Aztreonam; D014031:Tobramycin; D003091:Colistin