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Inhaled antibiotics are the backbone of care for people with cystic fibrosis (CF) who have lung infection due to Pseudomonas aeruginosa. They have significantly contributed to the improved quality of life (QOL) and increased survival in people with this disease.1 The systematic application of antibiotic eradication therapy for new or recurrent infections with P. aeruginosa and for long-term use of inhaled antibiotics in people with CF is now standard of care.1–3 There are currently two inhaled antibiotics licensed in the USA (tobramycin and aztreonam lysine) and four in Europe (tobramycin, aztreonam lysine, colistimethate sodium and levofloxacin).4–9 One of the current challenges of using inhaled antibiotics in CF is that tobramycin is licensed for use on alternate months, though clinical practice assessed from registries suggests that the majority of physicians when using tobramycin suggest a second antibiotic for the alternating months.10
Tobramycin inhalation by inhalation solution or dry powder has been available for 15 years and colistimethate sodium dry powder and has recently been licensed by the European Medicines Agency (EMA).5 ,7 Tobramycin given on alternate months improved forced expiratory volume in 1 s (FEV1) and reduced pulmonary exacerbations compared to placebo.9 Colistimethate sodium has only been tested in a head-to-head active comparator study against tobramycin and demonstrated non-inferiority in patients. It has not been studied in a large placebo-controlled trial.
Levofloxacin as an inhalation solution, though approved for over 18-year-olds in Europe, is not yet available to clinicians for use.8 This fluoroquinilone demonstrated good activity against …