113 Inhalative meropenem–tobramycin–colistin combination improves lung function in chronic Pseudomonas aeruginosa colonization

Abstract

Objectives Pseudomonas aeruginosa in the airways of CF-patients restricts the efficacy of antibiotics leading to chronic infections which have a large impact on morbidity and mortality. Antibiotic combination therapy might be more efficient than single antibiotics to combat lung infections in CF. Methods In an observational pilot study CF patients, suffering from chronic P. aeruginosa lung infection, pre-treated either with tobramycin or colistin, were inhalatively treated for 28 days with 300 mg tobramycin in combination with colistin (1 Mio IU) and meropenem 250 mg twice daily. Lung function expressed as expiratory volume in 1 second (FEV 1 ), bacterial cfu and adverse events were determined before and after treatment. Results 15 adult CF patients (mean age 27.9±9.4 years) inhaled b-sympathomimetics prior to the triple antibiotic solution which was well tolerated by all patients. FEV1 increased significantly by 7.8±5.7% absolute and 11.6±10% relative to baseline (p = 0.001) since only one patient showed no benefit after 28 days of inhalation. P. aeruginosa decreased significantly by 1.46±1.4 log cfu/ml (p = 0.042). No adverse reactions were found. Conclusion For the first time administered, the efficacy of an inhalative triple antibiotic solution with meropenem, tobramycin and colistin suggest, that this combination therapy seems to be safe and efficient to increase lung function and decrease chronic Pseudomonas infection in CF patients. This alternative combination of inhalative antibiotics has to be investigated in further trials.