Short-term Tolerance to Inhaled Antibiotics in Patients With Bronchial Infection not Associated With Cystic Fibrosis

Area of Science:

• Pulmonary Medicine
• Infectious Diseases
• Pharmacology

Background:

• Inhaled antibiotic therapy is controversial due to tolerance issues.
• Guidelines may discourage inhaled intravenous formulations if inhalation formulations exist.

Purpose of the Study:

• To compare the tolerance of inhaled antibiotics (colistimethate sodium, ampicillin, gentamicin) in patients with bronchial infections.
• To identify factors influencing antibiotic tolerance via nebulization.

Main Methods:

• Retrospective, observational, single-center study.
• 330 antibiotic tolerance tests in 135 patients with bronchial infection, chronic bronchial infection, and/or recurrent respiratory infections.
• Compared tolerance of inhaled colistimethate sodium versus intravenous ampicillin and gentamicin formulations.

Main Results:

• Colistimethate sodium (89.6% tolerance) was significantly better tolerated than gentamicin (69.5%) and ampicillin (69.1%).
• Odds of intolerance were 5.69 times higher for gentamicin and 6.21 times higher for ampicillin compared to colistimethate.
• Multivariate analysis indicated antibiotic type as the only significant factor influencing tolerance.

Conclusions:

• Inhaled sodium colistimethate demonstrates superior tolerance compared to inhaled intravenous formulations of ampicillin and gentamicin.
• Antibiotic type is the primary determinant of tolerance for inhaled administration in patients with respiratory infections.