title: Dry powder inhalers in cystic fibrosis: same old drugs but different benefits?
abstract: OBJECTIVE
  Newer 'innovative' formulations of antibiotics for Pseudomonas aeruginosa lung infection in patients with cystic fibrosis include colistimethate sodium and tobramycin in the form of dry powders for inhalation (DPIs). Whilst these DPIs are anticipated to improve patient adherence because of increased convenience and ease of administration, questions remain concerning whether they are as clinically effective, safe and cost-effective as nebulized antibiotics.
  
  
  RESULTS
  This review describes the recent findings of a health technology assessment of the clinical effectiveness and cost-effectiveness of colistimethate sodium and tobramycin DPIs with regard to how innovative treatments may be judged to be incrementally better than existing treatments. The original assessment was undertaken to inform the National Institute for Health and Care Excellence's Technology Appraisal Programme to inform national clinical guidance on the use of these new treatments in the National Health Service.
  
  
  CONCLUSIONS
  Three trials were included in the systematic review. Issues surrounding the clinical effectiveness and cost-effectiveness of colistimethate sodium DPI and tobramycin DPI are discussed in light of the considerable uncertainties associated with the available evidence.
authors.affiliation: The University of Sheffield, Sheffield, South Yorkshire, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Uttley
authors.forename: Paul
authors.initials: P
authors.lastname: Tappenden
mesh_terms: D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003091:Colistin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003362:Cost-Benefit Analysis; D003550:Cystic Fibrosis / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D058995:Dry Powder Inhalers; D006801:Humans; D055118:Medication Adherence; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D014031:Tobramycin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; C004691:colistinmethanesulfonic acid; D014031:Tobramycin; D003091:Colistin