Therapy of gram-negative infection in the complex treatment of cystic fibrosis

Abstract

Chronic lung infections are a consequence of the disturbance of mucociliary clearance process in cystic fibrosis. For most patients with cystic fibrosis, chronic lung infection is associated with a poor prognosis. The impact of chronic Pseudomonas aeruginosa infection on progressive deterioration of lung function and nutritional status has been established. Timely and effective antibiotic therapy aimed at eradication or control of gram-negative flora affects the duration and quality of life. The purpose of the study. To investigate the safety and efficacy of inhaled administration of sodium colistimethate (Colimistin®). Methods. The study enrolled 42 patients (27 patients aged 5 to 17 years and 15 patients over 18 years) with an established diagnosis of cystic fibrosis, 38 with monoculture of P. aeruginosa or various associations, 4 with Achromobacter spp. culture. Microbial status, external respiratory function, nutritional status, assessment of well-being, adverse reactions, exacerbations, and use of antibiotic therapy during colimistin inhalations were recorded in all patients at baseline and at 3 months. Results. A significant improvement in nutritional status in terms of weight (p < 0.007) and height (p < 0.001) was shown in the general patient group and the children’s group. In the group of children, there was a significant increase in weight (p < 0.034) and height (p < 0.0001). In the group of patients older than 18 years, there was a significant increase in weight (p < 0.045) and BMI three months after therapy (p < 0.013). There were no significant improvements in FVC and FEV1. The treatment efficacy was shown by the assessment of well-being in the general patient group (p < 0.001) and in the children’s group (p < 0.002). No significant difference was found in the adult patient group (p < 0.067). Two patients dropped out of the study due to ADR at the start of therapy. Conclusion. Sodium colistimethate showed efficacy and safety in bronchopulmonary infections caused by P. aeruginosa in monoculture and in association with Achromobacter spp. and may be recommended for use in children and adults with cystic fibrosis.