What is the efficacy of tobramycin inhalation solution on bronchiectasis?

Tobramycin inhalation solution has a good effect on bronchiectasis, can delay the damage to the lungs caused by the disease, and reduce uncomfortable symptoms such as repeated coughing, sputum, hemoptysis, and wheezing. In patients with bronchiectasis and chronic Pseudomonas aeruginosa infection, tobramycin inhalation solution is effective in reducing sputum bacterial density.

Tobramycin inhalation solution

It is an aminoglycoside antibacterial drug that mainly interferes with protein synthesis, causing changes in cell membrane permeability, gradually destroying the cell membrane, and ultimately leading to cell death. Tobramycin inhalation solution has in vitro antibacterial activity against Gram-negative bacteria including Pseudomonas aeruginosa.

Tobramycin inhalation solution for the treatment of bronchiectasis

Eligible adults with bronchiectasis were enrolled in a phase 3, 16-week, multicenter, randomized, double-blind, placebo-controlled trial. Inhalation of tobramycin inhalation solution (300 mg/5 mL twice daily) (n=167) or normal saline (5 mL twice daily) (n=172) was performed on the basis of routine care. Co-primary endpoints include changes from baseline in Pseudomonas aeruginosa density and quality of life bronchiectasis respiratory symptom scores at Day 29.

Compared with placebo, tobramycin inhalation solution significantly reduced Pseudomonas aeruginosa density (adjusted mean difference, 1.74 log10 colony-forming units/g; 95% CI, 1.12-2.35; P < .001) and quality of life, with greater improvement in bronchiectasis respiratory symptom scores.

Similar findings were observed on day 85. Tobramycin inhalation solution resulted in significant reductions in 24-hour sputum volume and sputum-pus score on days 29, 57, and 85. On day 29, more patients in the tobramycin inhalation solution group had negative cultures for Pseudomonas aeruginosa than in the placebo group, with percentages of 29.3% and 10.6% respectively.

Tobramycin inhalation solution is an effective treatment option with an acceptable safety profile for patients with bronchiectasis and Pseudomonas aeruginosa infection.

1. Bronchospasm: The use of tobramycin inhalation solution may cause bronchospasm. If bronchospasm occurs during the administration of tobramycin inhalation solution, symptomatic treatment should be based on the actual condition.

2. Ototoxicity: such as transient tinnitus, hearing loss, vertigo, ataxia or dizziness. Patients with known or suspected auditory or vestibular dysfunction should be closely monitored during use of tobramycin inhalation solution, including audiometry and testing of tobramycin plasma concentrations. If ototoxicity is detected, tobramycin inhalation solution should be temporarily discontinued promptly.

3. Nephrotoxicity: If kidney toxicity occurs, treatment should be carried out according to medical needs, including temporarily discontinuing tobramycin inhalation solution.

4. Neuromuscular diseases: Patients taking neuromuscular blockers at the same time may develop respiratory paralysis. If neuromuscular blockade occurs, it can be reversed by calcium salt treatment.

Contraindications

It is prohibited for those with a history of allergies to the components of tobramycin inhalation solution and other aminoglycoside antibiotics or bacitracin.

Summary

Tobramycin Inhalation Solution is an antibiotic that controls infection, thereby reducing the symptoms of bronchiectasis. The effect of tobramycin inhalation solution may be different for each person, so before use, it is recommended to consult a doctor and decide whether to use it based on the doctor's advice and personal circumstances.

References:

Guan WJ, Xu JF, Luo H, Xu XX, Song YL, Ma WL, Liang ZA, Liu XD, Zhang GJ, Zhang XJ, Li RK, Zhu SY, Zhang YJ, Cai XJ, Wei LP, Tian DB, Zhao H, Chen PY, Qu JM, Zhong NS; TORNASOL Study Group. A Double-Blind Randomized Placebo-Controlled Phase 3 Trial of Tobramycin Inhalation Solution in Adults With Bronchiectasis With Pseudomonas aeruginosa Infection. Chest. 2023 Jan;163(1):64-76. doi: 10.1016/j.chest.2022.07.007. Epub 2022 Jul 19. PMID: 35863486.

Recommended related hot articles: