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Review
. 2021 Mar 22;10(3):338.
doi: 10.3390/antibiotics10030338.

Cystic Fibrosis: Recent Insights into Inhaled Antibiotic Treatment and Future Perspectives

Giovanni Taccetti  1 , Michela Francalanci  1 , Giovanna Pizzamiglio  2 , Barbara Messore  3 , Vincenzo Carnovale  4 , Giuseppe Cimino  5 , Marco Cipolli  6
Affiliations
Review

Cystic Fibrosis: Recent Insights into Inhaled Antibiotic Treatment and Future Perspectives

Giovanni Taccetti et al. Antibiotics (Basel). .

Abstract

Although new inhaled antibiotics have profoundly improved respiratory diseases in cystic fibrosis (CF) patients, lung infections are still the leading cause of death. Inhaled antibiotics, i.e., colistin, tobramycin, aztreonam lysine and levofloxacin, are used as maintenance treatment for CF patients after the development of chronic Pseudomonas aeruginosa (P. aeruginosa) infection. Their use offers advantages over systemic therapy since a relatively high concentration of the drug is delivered directly to the lung, thus, enhancing the pharmacokinetic/pharmacodynamic parameters and decreasing toxicity. Notably, alternating treatment with inhaled antibiotics represents an important strategy for improving patient outcomes. The prevalence of CF patients receiving continuous inhaled antibiotic regimens with different combinations of the anti-P. aeruginosa antibiotic class has been increasing over time. Moreover, these antimicrobial agents are also used for preventing acute pulmonary exacerbations in CF. In this review, the efficacy and safety of the currently available inhaled antibiotics for lung infection treatment in CF patients are discussed, with a particular focus on strategies for eradicating P. aeruginosa and other pathogens. Moreover, the effects of long-term inhaled antibiotic therapy for chronic P. aeruginosa infection and for the prevention of pulmonary exacerbations is reviewed. Finally, how the mucus environment and microbial community richness can influence the efficacy of aerosolized antimicrobial agents is discussed.

Keywords: P. aeruginosa; cystic fibrosis; inhaled antibiotics; pulmonary exacerbations.

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Conflict of interest statement

T.G. reports an honorarium from Chiesi for educational planning, Vertex therapeutics, Mylan. M.B. reports participation on the Advisory Board for Chiesi, and P.I. for Zambon and Vertex. F.M., P.G., C.V., C.G. and C.M. have nothing to disclose.

Figures

Figure 1
Figure 1
Timetable of the most relevant milestones in the evolution of inhaled antibiotic therapy in cystic fibrosis.
Figure 2
Figure 2
Difference in time to PEx as first antipseudomonal antibiotic (ABX) treatment (black lines) and ABX treatment in the presence of symptoms (gray lines) from Fischer R. et al., Pediatr. Pulmonol. 2016, Suppl 45, 359, doi:10.1002/ppul.23573.
See this image and copyright information in PMC

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