Sequential Inhalational Tobramycin-Colistin-Combination in CF-Patients with Chronic P. Aeruginosa Colonization - an Observational Study.

BACKGROUND/AIMS: In cystic fibrosis (CF), chronic microbial lung infections are difficult to treat and cause morbidity and increased mortality. METHODS: In a multicentre, open-label, exploratory, non-interventional study, inhaled tobramycin (300 mg twice daily) and colistin (1 million I.U. twice daily) were sequentially combined with the aim to investigate the effect on 41 CF patients with chronic P. aeruginosa infections for six months (mean age 24 ± 10.8y). RESULTS: Six patients had adverse events that were assessed as being related to treatment. Mucus production and coughing both decreased in 39%, whereas FEV1 absolute and relative to baseline increased by 4.9% and 9.1%, respectively (p = 0.004) in 29 patients, who were definitely treated sequentially. Efficacy of the therapy was rated 'excellent' or 'good' by the physicians in 80.5% of the patients. CONCLUSIONS: The results indicate that treatment with inhaled antibiotics, sequentially combined, was very well tolerated by most patients and may have a beneficial effect, even if transitory on lung function and respiratory symptoms.

Omalizumab: a new treatment option for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis.

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) is a severe complication in patients with cystic fibrosis (CF), resulting in deterioration of lung function and impairment of overall prognosis. Standard therapy consists of high dosage, long-term corticosteroid treatment. This carries the risk of serious side effects such as immune suppression, diabetes and osteoporosis. Antifungal drugs such as itraconazole may cause interactions with other drugs and drug levels need to be monitored. Omalizumab treatment has been tried in several case studies. METHODS: This was a retrospective study of six patients (four female, two male, age 4-33 years old) with CF and ABPA treated with omalizumab within an observation period of 7.5 years. RESULTS: All patients showed clinical and laboratory stability or even an improvement within the treatment and post-treatment observation period, although omalizumab therapy was less effective in patients with progressed lung disease and long-term ABPA. Side effects of systemic steroids were reduced. CONCLUSION: Omalizumab has the potential to be an additional and solitary treatment option in patients with CF and ABPA. Early onset treatment may be beneficial and patients with early stage of lung disease seem to benefit more.