Tobramycin safety and efficacy review article

Pseudomonas aeruginosa is a common respiratory pathogen found in patients with cystic fibrosis (CF), contributing to increased hospitalization, more rapid progression of CF lung disease, and increased risk of death. Guidelines recommend early therapy using tobramycin inhaled solution (TIS) or inhaled powder (TIP). Both TIS and TIP treatment regimens have demonstrated positive clinical outcomes in efficacy and safety, including improvements in FEV₁, decreased sputum P. aeruginosa density, decreased rates in antipseudomonal antibiotic use, and reduced rates of hospitalizations due to respiratory events. In a comparison of patient preference for TIS versus TIP, a patient survey cited time savings and convenience as preferences for TIP. However, both TIP and TIS offer advantages that may benefit patients and increase treatment adherence depending on patient circumstances. TIS may be suitable for younger patients at home where parents and caregivers may better control proper administration, older individuals, and those with low FEV₁. Dry powder inhalers are suitable when patients have less time to commit to their self-care (eg, patients who work, are remotely located, return home late, or are on vacation), and can reduce the patient treatment burden compared with nebulized delivery. In this expert review, we summarize the available data on tobramycin regarding its molecular characteristics, mechanism of action, and efficacy and safety for the treatment of acute and chronic P. aeruginosa infection.