Non CF bronchiectasis: The effect of inhaled antibiotics (tobramycin and colistin) in patients with pseudomonas aeruginosa

Introduction: The efficacy of inhaled antibiotics in Cyctic Fibrosis(CF) has been documented. There is less information on non CF patients, the 30% of whom is colonized with P.aeruginosa (Pa) Aim: To evaluate the effect of inhaled tobramycin (Bramitob, Chiesi) and Colistimethatesodium (Colistin Norma) in patients with non CF bronchiectasis and Pa in sputum. Methods: Twenty nine patients were studied (19 women), mean age 56.06 yr (24-80), with >10 4 CFU of Pa/ ml in sputum culture. Patients were randomized in 3 groups: tobramycin 300mgx2 (group A, 10 patients), colistin 1MUx2 (group B, 10 patients), N/S 0.9% 4ccx2 (group C, 9 patients). Administration was done through Pari LC Plus jet nebulizer for 4 weeks. Symptoms, sputum purulence and culture, spirometry and SaO2 were estimated before and after treatment. Results: Improvement was found in groups A and B compared to placebo regarding: a)Pa density (p= 0.003, p=0.008, p=0.08 for groups A, B and C respectively) b)breathlessness ,MRC scale (p=0.035, p=0.015, p=0.34) c)sputum volume (p=0.005, p=0.009, p=0.08) d)sputum purulence (8/10 group A, 10/10 group B, 0/9 group C). Differences in spirometry and SaO2 were not significant. Adverse events were reported in 4/10, 2/10 and 3/9 in group A, B and C respectively, not requiring discontinuation of treatment. Conclusions: Our data indicate that inhaled antibiotics, tobramycin and colistin may be effective in improving symptoms and reducing Pa load in bronchiectatic patients. Further investigation is necessary.