The binding of anti-pseudomonal antibiotics to macromolecules from cystic fibrosis sputum.

Antibiotics are known to bind to whole cystic fibrosis sputum. However, the composition of sputum varies from one patient to another, making the interpretation of binding studies difficult. This problem has been examined by standardising the macromolecule concentration of sputum from four cystic fibrosis patients and adding tobramycin or ceftazidime directly to the sputum components. Binding to mucin-rich and DNA-rich fractions of sputum was also studied before and after DNase treatment of these fractions. These studies indicated that (i) the degree of tobramycin binding is dependent on the sputum macromolecule concentration, (ii) a significant proportion of tobramycin is bound even at concentrations of 100 mg/l of drug, (iii) tobramycin binds to both the mucin rich fraction and the DNA rich fraction of sputum and (iv) ceftazidime binding to sputum is negligible. Our data indicate that there is a need to standardise sputum in antibiotic binding studies and they provide another rationale for favouring the use of ceftazidime over aminoglycosides in infectious exacerbations of cystic fibrosis caused by Pseudomonas aeruginosa.