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Pediatr Pulmonol. 2010 Mar;45(3):281-90. doi: 10.1002/ppul.21176.

Inhaled versus systemic antibiotics and airway inflammation in children with cystic fibrosis and Pseudomonas.

Author information

1
Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7127, USA. terry_noah@med.unc.edu

Abstract

RATIONALE:

Inhaled tobramycin has been shown to transiently clear Pseudomonas from lower airways in early cystic fibrosis (CF), but does not markedly reduce lung inflammation, a key factor in disease progression.

OBJECTIVE:

Test the hypothesis that systemic antibiotics are more effective than inhaled antibiotics for reducing lower airways inflammation.

METHODS:

Clinically stable CF children with recent Pseudomonas were randomized to receive 4 weeks of inhaled tobramycin or 2 weeks of systemic antibiotics (intravenous ceftazidime and tobramycin). Bronchoalveolar lavage fluid was obtained just before and 4-6 weeks after treatment. The primary outcome was change in % neutrophils in lavage fluid.

RESULTS:

Fifteen subjects (inhaled = 6, systemic = 9) completed the protocol. Three Systemic Group subjects could not have central venous access established and were treated with oral ciprofloxacin (plus inhaled tobramycin) for 2 weeks as an alternative "systemic" regimen, per protocol. Groups were well matched in age, markers of disease severity, and initial % neutrophils. The Systemic Group showed a modest median change in percent neutrophils (-7%) which was not statistically significant compared to inhaled (+5.4%, P = 0.07). However, the Systemic Group had significantly greater reductions in total cells (-50% vs. -3%, P < 0.01) and neutrophils (-74% vs. -10%, P = 0.02) per ml lavage fluid. Both groups had reduced bacterial quantity after treatment, but there was no significant difference between groups.

CONCLUSIONS:

In clinically stable children with CF, systemic antibiotics result in greater short-term reduction in lower airways inflammation than inhaled antibiotics.

PMID:
20146365
DOI:
10.1002/ppul.21176
[Indexed for MEDLINE]

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