Tobramycin for inhalation in cystic fibrosis: Beyond respiratory improvements

European consensus guidelines recommend nebulised antibiotics for maintenance therapy in patients with cystic fibrosis and chronic Pseudomonas aeruginosa infection. Two formulations of tobramycin for inhalation are available in Europe (Tobi; Novartis AG, Switzerland; Bramitob; Chiesi Farmaceutici S.p.A., Italy). Data from a series of randomised controlled studies in patients with mild-to-moderate cystic fibrosis and chronic P. aeruginosa infection show that both Tobi and Bramitob significantly improve lung function and reduce the density of P. aeruginosa in sputum. Bacterial resistance may develop but does not seem to be clinically important. Other benefits, such as improved patient nutritional status and reductions in the need for hospitalisation, antipseudomonal antibiotics and productivity losses have also been documented with Tobi and Bramitob. Both formulations of inhaled tobramycin are well tolerated with no evidence of renal or ototoxicity. Improved patient compliance may be achieved through reducing nebulisation time, either by using Bramitob, which is formulated in a smaller volume than Tobi, or with new generation nebulisers. In conclusion, inhaled tobramycin not only improves lung function in patients with cystic fibrosis, but also offers other benefits which have implications for healthcare costs and patient quality of life.