Touw D J, Brimicombe R W, Hodson M E, Heijerman H G, Bakker W
Dept of Pharmacy, Free University Hospital, Amsterdam, The Netherlands.
Eur Respir J. 1995 Sep;8(9):1594-604.
Aerosol administration of antipseudomonal antibiotics is commonly used in cystic fibrosis. However, its contribution to the improvement of lung function, infection and quality of life is not well-established. All articles published from 1965 until the present time concerning the inhalation of antibiotics in cystic fibrosis were collected by computerized literature search and analysed. Effective aerosol delivery is compromised by nebulizers with limited capacity to produce particles in the respirable range. Twelve studies concerning maintenance treatment were published. Four uncontrolled studies evaluating antibiotic aerosol maintenance treatment in stable patients indicated a beneficial effect in terms of reducing the number of hospital admissions. Eight placebo-controlled studies were found; six of these showed a significant improvement of lung function in the treatment group. Four studies showed a reduction of the number of hospital admissions. In some studies, there was a considerable negative effect of the nebulized placebo solution on the outcome, probably due to the improper choice of its osmolarity. Studies with antibiotic aerosols as adjunct to intravenous therapy in cystic fibrosis patients with an acute exacerbation showed no enhancement of the clinical effects of the intravenous antibiotic by the aerosol; sputum colony counts, however, were lower. Toxicity studies carried out so far have shown no renal or ototoxicity; however, long-term toxicity studies still have to be performed using higher dosages. Introduction or selection of resistant bacteria is relatively rare, but remains a matter of concern. Aerosol maintenance treatment with an appropriate antibiotic in high enough dosage can be recommended for patients with cystic fibrosis chronically infected with P. aeruginosa, and may improve lung function and reduce the number of hospital admissions due to an acute exacerbation.
抗假单胞菌抗生素的雾化吸入常用于囊性纤维化患者。然而，其对改善肺功能、感染及生活质量的作用尚未完全明确。通过计算机文献检索收集并分析了1965年至今所有关于囊性纤维化患者吸入抗生素的文章。雾化器产生可吸入范围内颗粒的能力有限，影响了有效的气溶胶递送。共发表了12项关于维持治疗的研究。4项评估稳定期患者抗生素雾化维持治疗的非对照研究表明，在减少住院次数方面有有益作用。发现8项安慰剂对照研究；其中6项显示治疗组肺功能有显著改善。4项研究显示住院次数减少。在一些研究中，雾化安慰剂溶液对结果有相当大的负面影响，可能是由于其渗透压选择不当。在急性加重期的囊性纤维化患者中，将抗生素气雾剂作为静脉治疗辅助手段的研究表明，气雾剂并未增强静脉抗生素的临床效果；然而，痰菌落计数较低。目前进行的毒性研究未显示肾毒性或耳毒性；然而，仍需使用更高剂量进行长期毒性研究。耐药菌的引入或选择相对少见，但仍是一个令人担忧的问题。对于长期感染铜绿假单胞菌的囊性纤维化患者，可推荐使用足够高剂量的合适抗生素进行雾化维持治疗，这可能改善肺功能并减少因急性加重导致的住院次数。
