Bronchial reactions to the inhalation of high-dose tobramycin in cystic fibrosis

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Volume 20 Issue (1) Pages 122-126, 2002 ISSN 0903-1936

Bronchial reactions to the inhalation of high-dose tobramycin in cystic

fibrosis

W.H. Nikolaizik , K. Trociewicz , F. Ratjen

ABSTRACT: It has been established that inhaled tobramycin has a positive

effect on respiratory function in Pseudomonas-aeruginosa positive

patients with cystic fibrosis (CF). In a previous study the authors

reported that low-dose tobramycin preparations containing the

preservative phenol caused significant bronchial obstruction. Recently,

high-dose tobramycin preparations with and without preservatives/phenol

have become available.To assess the airway response to these preparations

flow/volume curves in 12 patients with CF (four males, eight females,

mean age±SD=19.0±7.4 yrs) were measured. The tobramycin preparations:

Nebicina® 2.0 mL (150 mg, containing the preservative phenol), Distobram®

3.0 mL (150 mg, containing preservatives), Tobi® 5.0 mL (300 mg), Tobi®

2.5 mL (150 mg), and Tobi® 5.0 mL, were used after bronchodilator

application.Immediately and/or 5 min after the tobramycin inhalations

there was a significant fall in lung function with the different

preparations. There was no significant difference between preparations

with and without preservatives/phenol. The bronchial obstruction was

comparable to that observed after the inhalation of low-dose tobramycin

and after saline. After 10 min of inhalation, the lung function returned

to baseline values. Most patients preferred the Tobi® 2.5 mL and disliked

the Nebicina® preparation due to the unpleasant taste. Preceding

treatment with bronchodilators prevented the decline in lung

function.Assessment of bronchial response at the first nebulisation of

high-dose tobramycin and, in case of significant obstruction, b-agonists

in combination with the antibiotic inhalation are recommended.

AFFILIATION:

Dept of Paediatrics, University Hospital Essen, Essen, Germany

CORRESPONDENCE: W.H. Nikolaizik, Dept of Paediatrics, University Hospital

Essen, Hufelandstr. 55, 45122, Essen, Germany,

Fax: 49 2017235721.

Email: wilfried.nikolaizik@...