title: New Inhaled Antimicrobial Formulations for Use in the Cystic Fibrosis Patient Population.
abstract: OBJECTIVE
  To review the current literature on inhaled antibiotic therapies currently in clinical trials for cystic fibrosis (CF) patients.
  
  
  METHODS
  A literature search was performed using PubMed (1975 to September 2015), International Pharmaceutical Abstracts (1970 to September 2015), and MEDLINE (1946 to September 2015) to identify studies for inclusion. The following search terms were used: cystic fibrosis, inhaled amikacin, inhaled liposomal amikacin, inhaled vancomycin, and/or inhaled levofloxacin.
  
  
  METHODS
  All English-language phase II to III studies evaluating efficacy and/or safety, case reports, and retrospective studies of inhaled amikacin, inhaled vancomycin, and inhaled levofloxacin in CF patients were included.
  
  
  RESULTS
  Currently available inhaled antibiotics, tobramycin and aztreonam, have demonstrated improvement in respiratory function of CF patients. Newer agents have shown potentially similar efficacy, with improvement in ease of use. Limited data suggest that inhaled liposomal amikacin and levofloxacin are both noninferior to tobramycin in terms of improvements in respiratory function. Inhaled levofloxacin has a lower rate of hospitalizations secondary to respiratory exacerbations and a reduction in the Pseudomonas aeruginosa sputum density compared with inhaled tobramycin. Inhaled vancomycin use has been documented in case reports and 2 small retrospective eradication trials, although data are limited to support its use.
  
  
  CONCLUSIONS
  The horizon of inhaled antibiotic choices for CF patients is promising. The introduction of different drug classes and formulations to treat resistant Gram-negative and Gram-positive organisms increases the number of options for patients for both eradication and treatment of chronic colonization.
authors.affiliation: Georgia Regents Medical Center, Augusta, GA USA University of Georgia College of Pharmacy, Augusta, GA, USA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Campbell
authors.affiliation: University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA.
authors.forename: Rachael
authors.initials: R
authors.lastname: McCaleb
authors.affiliation: University of Georgia College of Pharmacy, Augusta, GA, USA kmanasco@gru.edu.
authors.forename: Kalen B
authors.initials: KB
authors.lastname: Manasco
mesh_terms: D000280:Administration, Inhalation; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003550:Cystic Fibrosis / Q000188:drug therapy*; D006801:Humans; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents
keywords: amikacin; cystic fibrosis; inhaled antibiotic; levofloxacin; vancomycin