69 Efficacy on lung function and safety of multiple courses of tobramycin 300mg/4mL nebuliser solution (Bramitob) in patients with cystic fibrosis and chronic Pseudomonas aeruginosa infection: results from a 48-week extension phase

Abstract

Objectives: Chronic treatment with inhaled antibiotics is part of the treatment regimen for cystic fibrosis patients chronically colonized with Pseudomonas aeruginosa. Previously available treatments included nebulized antibiotics, but use of available preparations could be burdensome for patients and families. Two “newgeneration” formulations recently become available in Canada. We describe early experiences with Tobramycin Inhalation Powder (TIP, TOBI® Podhaler®) in a large pediatric CF centre. Methods: Patients who had initiated therapy with TIP were identified by retrospective chart review and demographic information was recorded (patient age, sex, CFTR mutation, culture results over 12 months, and treatment before starting TIP). Patients who ceased using TIP were identified. Data: TIP first became commercially available in Canada in April 2011. There are 170 patients between the ages of 6−18 years enrolled in the CHU-Sainte Justine clinic. As of January 2012, 32 patients had started therapy with TIP (mean age: 13.4 years (range 6−18 years, SD = 3.1 years), 14 females/18 males. 22 DF508 homozygous, 7 others with one DF508 allele). All were chronically colonized with P. aeruginosa; 31 also had other organisms. Before TIP, 12 were treated with TOBI®, 8 tobramycin, 9 colymycin, 1 tobramycin + colymycin, and 2 untreated. Three patients stopped therapy: 1 due to poor Podhaler technique, 1 bronchospasm, and 1 negative cultures for P. aeruginosa for 1 year. Conclusion: Early clinical experience with TIP in our centre has been positive, with initiation of therapy in 32 patients to date. Only 3 have stopped therapy, 2 due to factors associated with TIP.