Inhaled Tobramycin Therapy

Cystic Fibrosis Bronchiectasis

The American Thoracic Society recommends inhaled tobramycin for patients with cystic fibrosis who are 6 years and older with Pseudomonas aeruginosa infection, as it improves lung function, reduces exacerbations, and decreases hospitalization rates 1, 2, 3
Intermittent therapy (28 days on, 28 days off) has shown conclusive benefits in a multicenter study of 520 CF patients, with a strong recommendation (Grade A) for moderate to severe disease and a recommendation (Grade B) for mild disease 2, 4
Inhaled tobramycin is indicated for patients 6 years and older with P. aeruginosa persistently present in airway cultures, with high certainty of substantial net benefit 3

The European Respiratory Society states there is insufficient evidence to recommend routine use of nebulized tobramycin in non-CF bronchiectasis, although it may be considered in patients with chronic P. aeruginosa infection who have frequent exacerbations or hospitalizations 1

Airway clearance techniques should be performed before inhalation to improve drug delivery, and pre-treatment with bronchodilators is recommended to prevent bronchospasm 4, 5, 6
Regular sputum cultures should be performed to monitor bacterial density and development of resistance, with consideration of monitoring serum levels in patients receiving high doses 4, 5

Inhaled colistin is used as an alternative but has shown less efficacy than tobramycin in comparative studies, while other inhaled antibiotics (gentamicin, ceftazidime) have insufficient evidence to recommend their routine use 3, 7
The therapy is generally well-tolerated with no significant systemic toxicity at recommended doses, although caution is advised in patients with known kidney disease or ear disorders 4, 5