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Southwest Pulmonary and Critical Care Fellowships
In Memoriam

Pulmonary Journal Club

(Click on title to be directed to posting, most recent listed first)

May 2017 Phoenix Pulmonary/Critical Care Journal Club
October 2015 Phoenix Pulmonary Journal Club: Lung Volume Reduction
September 2015 Tucson Pulmonary Journal Club: Genomic Classifier
   for Lung Cancer
April 2015 Phoenix Pulmonary Journal Club: Endo-Bronchial Ultrasound in
   Diagnosing Tuberculosis
February 2015 Tucson Pulmonary Journal Club: Fibrinolysis for PE
January 2015 Tucson Pulmonary Journal Club: Withdrawal of Inhaled
    Glucocorticoids in COPD
January 2015 Phoenix Pulmonary Journal Club: Noninvasive Ventilation In 
   Acute Respiratory Failure
September 2014 Tucson Pulmonary Journal Club: PANTHEON Study
June 2014 Tucson Pulmonary Journal Club: Pirfenidone in Idiopathic
   Pulmonary Fibrosis
September 2014 Phoenix Pulmonary Journal Club: Inhaled Antibiotics
August 2014 Phoenix Pulmonary Journal Club: The Use of Macrolide
   Antibiotics in Chronic Respiratory Disease
June 2014 Phoenix Pulmonary Journal Club: New Therapies for IPF
   and EBUS in Sarcoidosis
March 2014 Phoenix Pulmonary Journal Club: Palliative Care
February 2014 Phoenix Pulmonary Journal Club: Smoking Cessation
January 2014 Pulmonary Journal Club: Interventional Guidelines
December 2013 Tucson Pulmonary Journal Club: Hypothermia
December 2013 Phoenix Pulmonary Journal Club: Lung Cancer
   Screening
November 2013 Tucson Pulmonary Journal Club: Macitentan
November 2013 Phoenix Pulmonary Journal Club: Pleural Catheter
   Infection
October 2013 Tucson Pulmonary Journal Club: Tiotropium Respimat 
October 2013 Pulmonary Journal Club: Pulmonary Artery
   Hypertension
September 2013 Pulmonary Journal Club: Riociguat; Pay the Doctor
August 2013 Pulmonary Journal Club: Pneumococcal Vaccine
   Déjà Vu
July 2013 Pulmonary Journal Club
June 2013 Pulmonary Journal Club
May 2013 Pulmonary Journal Club
March 2013 Pulmonary Journal Club
February 2013 Pulmonary Journal Club
January 2013 Pulmonary Journal Club
December 2012 Pulmonary Journal Club
November 2012 Pulmonary Journal Club
October 2012 Pulmonary Journal Club
September 2012 Pulmonary Journal Club
August 2012 Pulmonary Journal Club
June 2012 Pulmonary Journal Club
June 2012 Pulmonary Journal Club
May 2012 Pulmonary Journal Club
April 2012 Pulmonary Journal Club
March 2012 Pulmonary Journal Club
February 2012 Pulmonary Journal Club
January 2012 Pulmonary Journal Club
December 2011 Pulmonary/Sleep Journal Club
October, 2011 Pulmonary Journal Club
September, 2011 Pulmonary Journal Club
August, 2011 Pulmonary Journal Club
July 2011 Pulmonary Journal Club
May, 2011 Pulmonary Journal Club
April, 2011 Pulmonary Journal Club
February 2011 Pulmonary Journal Club 
January 2011 Pulmonary Journal Club 
December 2010 Pulmonary Journal Club

 

Both the Phoenix Good Samaritan/VA and the Tucson University of Arizona fellows previously had a periodic pulmonary journal club in which current or classic pulmonary articles were reviewed and discussed. A brief summary was written of each discussion describing thearticle and the strengths and weaknesses of each article.

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Entries in gentamicin (1)

Friday
Sep192014

September 2014 Phoenix Pulmonary Journal Club: Inhaled Antibiotics

The September 2014 pulmonary journal club focused on the utilization of inhaled antibiotics in non-cystic fibrosis (CF) bronchiectasis.

A total of four papers were reviewed, inhaled tobramycin (1), inhaled gentamicin (2),  inhaled colistin (3) and Inhaled aztreonam (4).  Each of the trials were randomized, placebo-controlled trials with small sample sizes. An aggregate sample size from all four trials totaled 255 patients in the treatment arms. The largest sample size was seen in the aztreonam trial with 134 patients in the treatment group vs. 132 in the placebo group while the smallest was in the inhaled tobramycin, with 16 patients in the treatment arm vs. 15 in placebo. The inhaled tobramycin and gentamicin studies looked at reduction in bacterial colony forming units and sputum density, whereas the inhaled colistin and aztreonam studies incorporated time to exacerbations and quality of life indicators. None of the studies incorporated an airway clearance modality. 

The results of the studies were not impressive. In the tobramycin and gentamicin trials the primary endpoints of a reduction of bacterial load and sputum density were reached but the effects were only sustained while on therapy.  The colistin trial was the most promising as it showed that a > 80% adherence to inhaled therapy resulted in reduction in Pseudomonas bacterial load, improved quality of life and a delay in time to the first exacerbation. The aztreonam study was the largest of the four trials and looked at quality of life as its primary endpoint but failed to achieve its goal. 

In the four trials the medications were well tolerated with main side effects being airway irritation and bronchospasm. There were no systemic side effects and the use of inhaled therapy did not change the bacterial resistance pattern.

The role of inhaled antibiotics in non-CF bronchiectasis remains unknown as the data is lacking. Translating what we know about CF bronchiectasis and applying it to non-CF bronchiectasis has not been successful.  Future trials need to incorporate an airway treatment protocol such as flutter valve or chest vest therapy, and continue to use varying doses durations of therapy. The mechanism of action on the meds vary from bactericidal  (colistin, aztreonam) to bacteriostatic (gentamicin, tobramycin), perhaps looking at a combination inhaled therapy for synergy is warranted? For now all we know from inhaled antibiotic therapy in non-CF bronchiectasis is that it’s fairly well tolerated with no significant systemic toxicity but its efficacy is unproven.

M Mathew, MD FCCP MCCM

Associate Editor

References

  1. Couch LA. Treatment With tobramycin solution for inhalation in bronchiectasis patients with Pseudomonas aeruginosa. Chest. 2001;120(3 Suppl):114S-117S. [CrossRef] [PubMed]
  2. Murray MP, Govan JR, Doherty CJ, Simpson AJ, Wilkinson TS, Chalmers JD, Greening AP, Haslett C, Hill AT. A randomized controlled trial of nebulized gentamicin in non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2011;183(4):491-9. [CrossRef] [PubMed]
  3. Haworth CS, Foweraker JE, Wilkinson P, Kenyon RF, Bilton D. Inhaled colistin in patients with bronchiectasis and chronic Pseudomonas aeruginosa infection. Am J Respir Crit Care Med. 2014;189(8):975-82. [CrossRef] [PubMed]
  4. Barker AF, O'Donnell AE, Flume P, et al. Aztreonam for inhalation solution in patients with non-cystic fibrosis bronchiectasis (AIR-BX1 and AIR-BX2): two randomised double-blind, placebo-controlled phase 3 trials. Lancet Respir Med. 2014;2(9):738-49. [CrossRef] [PubMed]

Reference as: Mathew M. September 2014 Phoenix pulmonary journal club. inhaled antibiotics. Southwest J Pulm Crit Care. 2014;9(3):187-8. doi: http://dx.doi.org/10.13175/swjpcc125-14 PDF