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https://www.readbyqxmd.com/read/29098998/the-emergence-of-multidrug-resistant-pseudomonas-aeruginosa-in-cystic-fibrosis-patients-on-inhaled-antibiotics
#1
Atqah AbdulWahab, Khalid Zahraldin, Mazen A Sid Ahmed, Sulieman Abu Jarir, Mohammed Muneer, Shehab F Mohamed, Jemal M Hamid, Abubaker A I Hassan, Emad Bashir Ibrahim
INTRODUCTION: Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is an important and growing issue in the care of patients with cystic fibrosis (CF), and a major cause of morbidity and mortality. OBJECTIVE: The objective of the study was to describe the frequency of MDR-PA recovered from the lower respiratory samples of pediatric and adult CF patients, and its antibiotic resistance pattern to commonly used antimicrobial agents including β-lactams, aminoglycosides, and fluoroquinolones...
November 2017: Lung India: Official Organ of Indian Chest Society
https://www.readbyqxmd.com/read/29062489/staphylococcus-aureus-interaction-with-pseudomonas-aeruginosa-biofilm-enhances-tobramycin-resistance
#2
T Beaudoin, Y C W Yau, P J Stapleton, Y Gong, P W Wang, D S Guttman, V Waters
Antimicrobial resistance is a significant threat to the treatment of infectious disease. Multiple mechanisms of resistance to different classes of antibiotics have been identified and well-studied. However, these mechanisms are studied with bacteria in isolation, whereas often, infections have a polymicrobial basis. Using a biofilm slide chamber model, we visualized the formation and development of clinical Pseudomonas aeruginosa biofilms in the presence of secreted Staphylococcus aureus exoproducts, two bacteria that commonly co-infect pediatric patients with cystic fibrosis...
2017: NPJ Biofilms and Microbiomes
https://www.readbyqxmd.com/read/29053080/aerosolizing-lipid-dispersions-enables-antibiotic-transport-across-mimics-of-the-lung-airway-surface-even-in-the-presence-of-pre-existing-lipid-monolayers
#3
Steven V Iasella, Amy Z Stetten, Timothy E Corcoran, Stephen Garoff, Todd M Przybycien, Robert D Tilton
BACKGROUND: Secondary lung infections are the primary cause of morbidity associated with cystic fibrosis lung disease. Aerosolized antibiotic inhalation is potentially advantageous but has limited effectiveness due to altered airway aerodynamics and deposition patterns that limit drug access to infected regions. One potential strategy to better reach infected areas is to formulate aerosols with surfactants that induce surface tension gradients and drive postdeposition drug dispersal via Marangoni transport along the airway surface liquid (ASL)...
October 20, 2017: Journal of Aerosol Medicine and Pulmonary Drug Delivery
https://www.readbyqxmd.com/read/29029057/patient-specific-modelling-of-regional-tobramycin-concentration-levels-in-airways-of-patients-with-cystic-fibrosis-can-we-dose-once-daily
#4
Aukje C Bos, Johan W Mouton, Mireille van Westreenen, Eleni-Rosalina Andrinopoulou, Hettie M Janssens, Harm A W M Tiddens
Background: Inhaled tobramycin is important in the treatment of Pseudomonas aeruginosa ( Pa ) infections in cystic fibrosis (CF). However, despite its use it fails to attenuate the clinical progression of CF lung disease. The bactericidal efficacy of tobramycin is known to be concentration-dependent and hence changing the dosing regimen from a twice-daily (q12h) inhalation to a once-daily (q24h) inhaled double dose could improve treatment outcomes. Objectives: To predict local concentrations of nebulized tobramycin in the airways of patients with CF, delivered with the small airway-targeting Akita ® system or standard PARI-LC ® Plus system, with different inspiratory flow profiles...
September 23, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28854668/current-and-future-therapies-for-pseudomonas-aeruginosa-infection-in-patients-with-cystic-fibrosis
#5
Wynne D Smith, Emmanuelle Bardin, Loren Cameron, Claire L Edmondson, Katie V Farrant, Isaac Martin, Ronan A Murphy, Odel Soren, Andrew R Turnbull, Natasha Wierre-Gore, Eric W Alton, Jacob G Bundy, Andrew Bush, Gary J Connett, Saul N Faust, Alain Filloux, Paul S Freemont, Andrew L Jones, Zoltan Takats, Jeremy S Webb, Huw D Williams, Jane C Davies
Pseudomonas aeruginosa opportunistically infects the airways of patients with cystic fibrosis and causes significant morbidity and mortality. Initial infection can often be eradicated though requires prompt detection and adequate treatment. Intermittent and then chronic infection occurs in the majority of patients. Better detection of P. aeruginosa infection using biomarkers may enable more successful eradication before chronic infection is established. In chronic infection P. aeruginosa adapts to avoid immune clearance and resist antibiotics via efflux pumps, β-lactamase expression, reduced porins and switching to a biofilm lifestyle...
August 1, 2017: FEMS Microbiology Letters
https://www.readbyqxmd.com/read/28750737/low-dose-nitric-oxide-as-targeted-anti-biofilm-adjunctive-therapy-to-treat-chronic-pseudomonas-aeruginosa-infection-in-cystic-fibrosis
#6
Robert P Howlin, Katrina Cathie, Luanne Hall-Stoodley, Victoria Cornelius, Caroline Duignan, Raymond N Allan, Bernadette O Fernandez, Nicolas Barraud, Ken D Bruce, Johanna Jefferies, Michael Kelso, Staffan Kjelleberg, Scott A Rice, Geraint B Rogers, Sandra Pink, Caroline Smith, Priya S Sukhtankar, Rami Salib, Julian Legg, Mary Carroll, Thomas Daniels, Martin Feelisch, Paul Stoodley, Stuart C Clarke, Gary Connett, Saul N Faust, Jeremy S Webb
Despite aggressive antibiotic therapy, bronchopulmonary colonization by Pseudomonas aeruginosa causes persistent morbidity and mortality in cystic fibrosis (CF). Chronic P. aeruginosa infection in the CF lung is associated with structured, antibiotic-tolerant bacterial aggregates known as biofilms. We have demonstrated the effects of non-bactericidal, low-dose nitric oxide (NO), a signaling molecule that induces biofilm dispersal, as a novel adjunctive therapy for P. aeruginosa biofilm infection in CF in an ex vivo model and a proof-of-concept double-blind clinical trial...
September 6, 2017: Molecular Therapy: the Journal of the American Society of Gene Therapy
https://www.readbyqxmd.com/read/28662114/novel-glycopolymer-sensitizes-burkholderia-cepacia-complex-isolates-from-cystic-fibrosis-patients-to-tobramycin-and-meropenem
#7
Vidya P Narayanaswamy, Scott Giatpaiboon, Shenda M Baker, William P Wiesmann, John J LiPuma, Stacy M Townsend
Burkholderia cepacia complex (Bcc) infection, associated with cystic fibrosis (CF) is intrinsically multidrug resistant to antibiotic treatment making eradication from the CF lung virtually impossible. Infection with Bcc leads to a rapid decline in lung function and is often a contraindication for lung transplant, significantly influencing morbidity and mortality associated with CF disease. Standard treatment frequently involves antibiotic combination therapy. However, no formal strategy has been adopted in clinical practice to guide successful eradication...
2017: PloS One
https://www.readbyqxmd.com/read/28643178/economic-evaluation-of-tobramycin-inhalation-powder-for-the-treatment-of-chronic-pulmonary-pseudomonas-aeruginosa-infection-in-patients-with-cystic-fibrosis
#8
Srilekha Panguluri, Praveen Gunda, Laurie Debonnett, Kamal Hamed
BACKGROUND: Chronic lung infection with Pseudomonas aeruginosa occurs in approximately 50% of patients with cystic fibrosis (CF). This infection further compromises lung function, and significantly contributes to the increased healthcare costs. OBJECTIVES: Inhaled tobramycin, used to manage P. aeruginosa infection in CF patients, is available as powder (tobramycin inhalation powder, TIP) and solution (tobramycin inhalation solution, TIS). Evidence suggests increased adherence with the use of TIP over TIS...
August 2017: Clinical Drug Investigation
https://www.readbyqxmd.com/read/28634121/population-pharmacokinetics-of-tobramycin-inhalation-solution-in-pediatric-patients-with-cystic-fibrosis
#9
Xinting Wang, Stephan Koehne-Voss, SivaNaga S Anumolu, Jing Yu
Tobramycin inhalation solution given as a twice daily inhalation of nebulized aerosols of 300 mg is approved for the treatment of Pseudomonas aeruginosa infection in cystic fibrosis patients over 6 years of age. To investigate tobramycin pharmacokinetics (PK) after inhalation of tobramycin in pediatric cystic fibrosis patients below 7 years, a population PK approach was used to evaluate tobramycin PK data in patients 6 months to 44 years of age from 4 clinical studies. The final model used a 2-compartmental, first-order absorption model with effect of body mass index on the apparent central volume of distribution...
June 17, 2017: Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/28614995/ease-of-use-of-tobramycin-inhalation-powder-compared-with-nebulized-tobramycin-and-colistimethate-sodium-a-crossover-study-in-cystic-fibrosis-patients-with-pulmonary-pseudomonas-aeruginosa-infection
#10
James Greenwood, Carsten Schwarz, Urte Sommerwerck, Edward F Nash, Michael Tamm, Weihua Cao, Paul Mastoridis, Laurie Debonnett, Kamal Hamed
BACKGROUND: This study assessed the ease of use of tobramycin inhalation powder (TIP) administered via T-326 inhaler versus tobramycin inhalation solution (TIS) and colistimethate sodium (COLI), both administered via nebulizers, for the treatment of chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis (CF). METHODS: A real-world, open-label, crossover, interventional phase IV study was conducted in CF patients aged ⩾6 years with forced expiratory volume in 1 second (FEV1) ⩾25% to ⩽90% predicted...
July 2017: Therapeutic Advances in Respiratory Disease
https://www.readbyqxmd.com/read/28490864/adherence-to-tobramycin-inhaled-powder-vs-inhaled-solution-in-patients-with-cystic-fibrosis-analysis-of-us-insurance-claims-data
#11
Kamal Hamed, Valentino Conti, Hengfeng Tian, Emil Loefroth
PURPOSE: Tobramycin inhalation powder (TIP), the first dry-powder inhaled antibiotic for pulmonary Pseudomonas aeruginosa infection, is associated with reduced treatment burden, increased patient satisfaction, and higher self-reported adherence for cystic fibrosis (CF) patients. We compared adherence in CF patients newly treated with TIP with those newly treated with the traditional tobramycin inhalation solution (TIS), using US insurance claims data. PATIENTS AND METHODS: From the Truven MarketScan(®) database, we identified CF patients chronically infected with P...
2017: Patient Preference and Adherence
https://www.readbyqxmd.com/read/28479113/pharmacotherapy-for-non-cystic-fibrosis-bronchiectasis-results-from-an-ntm-info-research-patient-survey-and-the-bronchiectasis-and-ntm-research-registry
#12
Emily Henkle, Timothy R Aksamit, Alan F Barker, Jeffrey R Curtis, Charles L Daley, M Leigh Anne Daniels, Angela DiMango, Edward Eden, Kevin Fennelly, David E Griffith, Margaret Johnson, Michael R Knowles, Amy Leitman, Philip Leitman, Elisha Malanga, Mark L Metersky, Peadar G Noone, Anne E O'Donnell, Kenneth N Olivier, Delia Prieto, Matthias Salathe, Byron Thomashow, Gregory Tino, Gerard Turino, Susan Wisclenny, Kevin L Winthrop
BACKGROUND: Non-cystic fibrosis bronchiectasis ("bronchiectasis") is a chronic inflammatory lung disease often associated with nontuberculous mycobacteria (NTM) infection. Very little data exist to guide bronchiectasis management decisions. We sought to describe patterns of inhaled corticosteroid (ICS) and antibiotic therapy in the United States. METHODS: We invited 2,000 patients through NTM Info & Research (NTMir) to complete an anonymous electronic survey. We separately queried baseline clinical and laboratory data from the US Bronchiectasis and NTM Research Registry (BRR)...
May 5, 2017: Chest
https://www.readbyqxmd.com/read/28478753/antibiotic-prescription-patterns-in-spanish-cystic-fibrosis-patients-results-from-a-national-multicenter-study
#13
Juan de Dios Caballero, Rosa Girón, Rosa Del Campo, Concepción Prados, María-Isabel Barrio, Antonio Salcedo, Rafael Cantón
OBJECTIVE: Information about antibiotic prescription patterns for cystic fibrosis (CF) patients and, specifically, about inhaled treatment strategies for their management is lacking in Spain due to the absence of a national patient registry. In this study we present data about antibiotic prescription in the Spanish CF context that were obtained in a multicenter study, being inhaled treatment strategies the special focus of this work. METHODS: Twenty-four specialized CF units (12 adult, 12 pediatric) from 17 tertiary-care hospitals covering all Spanish Autonomous Communities provided sputa and clinical data from 15 consecutive patients...
May 1, 2017: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/28470103/tobramycin-inhalation-powder-for-the-treatment-of-pulmonary-pseudomonas-aeruginosa-infection-in-patients-with-cystic-fibrosis-a-review-based-on-clinical-evidence
#14
Kamal Hamed, Laurie Debonnett
Chronic airway infection with Pseudomonas aeruginosa is a major cause of increased morbidity and mortality in patients with cystic fibrosis (CF). The development and widespread use of nebulized antibacterial therapies, including tobramycin inhalation solution (TIS), has led to improvements in lung function and quality of life. However, the use of nebulizers is associated with various challenges, including extended administration times and the need for frequent device cleaning and disinfection. Multiple therapies are required for patients with CF, which poses a considerable burden to patients, and adherence to the recommended treatments remains a challenge...
May 2017: Therapeutic Advances in Respiratory Disease
https://www.readbyqxmd.com/read/28450200/aerosolized-tobramycin-for-pseudomonas-aeruginosa-ventilator-associated-pneumonia-in-patients-with-acute-respiratory-distress-syndrome
#15
Yohei Migiyama, Susumu Hirosako, Kentaro Tokunaga, Emi Migiyama, Takahiro Tashiro, Katsuyuki Sagishima, Hidenobu Kamohara, Yoshihiro Kinoshita, Hirotsugu Kohrogi
BACKGROUND: Ventilator-associated pneumonia (VAP) due to Pseudomonas aeruginosa has a high mortality and recurrence rate, especially in patients with acute respiratory distress syndrome (ARDS). Therefore, new therapeutic strategies against severe pneumonia are needed. This study evaluated the efficacy of aerosolized tobramycin for P. aeruginosa VAP in ARDS patients. METHODS: A retrospective analysis was performed on patients who developed VAP caused by P. aeruginosa during the course of ARDS at the intensive care unit (ICU) of Kumamoto University Hospital...
August 2017: Pulmonary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28440853/antibiotic-strategies-for-eradicating-pseudomonas-aeruginosa-in-people-with-cystic-fibrosis
#16
REVIEW
Simon C Langton Hewer, Alan R Smyth
BACKGROUND: Respiratory tract infection with Pseudomonas aeruginosa occurs in most people with cystic fibrosis. Once chronic infection is established, Pseudomonas aeruginosa is virtually impossible to eradicate and is associated with increased mortality and morbidity. Early infection may be easier to eradicate.This is an update of a Cochrane review first published in 2003, and previously updated in 2006, 2009 and 2014. OBJECTIVES: To determine whether antibiotic treatment of early Pseudomonas aeruginosa infection in children and adults with cystic fibrosis eradicates the organism, delays the onset of chronic infection, and results in clinical improvement...
April 25, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28418683/physical-characterization-of-tobramycin-inhalation-powder-ii-state-diagram-of-an-amorphous-engineered-particle-formulation
#17
Danforth P Miller, Trixie Tan, John Nakamura, Richard J Malcolmson, Thomas E Tarara, Jeffry G Weers
Tobramycin Inhalation Powder (TIP) is a spray-dried engineered particle formulation used in TOBI Podhaler, a drug-device combination for treatment of cystic fibrosis (CF). A TIP particle consists of two phases: amorphous, glassy tobramycin sulfate and a gel-phase phospholipid (DSPC). The objective of this work was to characterize both the amorphous and gel phases following exposure of TIP to a broad range of RH and temperature. Because, in principle, changes in either particle morphology or the solid-state form of the drug could affect drug delivery or biopharmaceutical properties, understanding physical stability was critical to development and registration of this product...
May 1, 2017: Molecular Pharmaceutics
https://www.readbyqxmd.com/read/28337076/nebulized-gentamicin-as-an-alternative-to-nebulized-tobramycin-for-tracheitis-in-pediatric-patients
#18
Justin K Chen, Brittany L Martin-McNew, Lisa M Lubsch
OBJECTIVES: Tracheitis is an infection of the lower respiratory tract and is defined by the US Centers for Disease Control and Prevention (CDC) based on signs and symptoms with no radiographic evidence of pneumonia. One method of treatment involves the use of tobramycin given by nebulizer. The purpose of this study was to compare the safety and efficacy of nebulized gentamicin with nebulized tobramycin. METHODS: This study was conducted in patients under 21 years of age who received greater than or equal to 1 day of gentamicin, 80 mg, or tobramycin, 300 mg, given twice a day by nebulization within the 14-month study period...
January 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28262569/pilot-trial-of-tobramycin-inhalation-powder-in-cystic-fibrosis-patients-with-chronic-burkholderia-cepacia-complex-infection
#19
Valerie Waters, Yvonne Yau, Trevor Beaudoin, Jillian Wettlaufer, Sean Kevin Tom, Nancy McDonald, Leena Rizvi, Michelle Klingel, Felix Ratjen, Elizabeth Tullis
There is no effective chronic suppressive therapy Burkholderia cepacia complex infection in cystic fibrosis (CF) patients. This was a pilot, open-label clinical trial of tobramycin inhalation powder (TIP) delivered via Podhaler twice daily for 28days in adults and children with CF and chronic B. cepacia complex infection in Toronto, Canada. A total of 10 subjects (4 pediatric, 6 adult patients) were treated. There was a mean drop of 1.4 log (CFU/ml) in sputum bacterial density (p=0.01) and sputum IL-8 levels decreased significantly after 28days of TIP (p=0...
July 2017: Journal of Cystic Fibrosis: Official Journal of the European Cystic Fibrosis Society
https://www.readbyqxmd.com/read/28184305/once-daily-aerosolised-tobramycin-in-adult-patients-with-cystic-fibrosis-in-the-management-of-pseudomonas-aeruginosa-chronic-infection
#20
Marco Mantero, Andrea Gramegna, Giovanna Pizzamiglio, Alice D'Adda, Paolo Tarsia, Francesco Blasi
It is estimated that about 60-70% of Cystic Fibrosis patients develop Pseudomonas aeruginosa chronic infection, with progressive loss of lung function, as well as increased antibiotic resistance and mortality. The current strategy is to maintain lung function by chronic suppressive antipseudomonas antibiotic therapy. Tobramycin inhalation solution was the first approved aerosolised antibiotic to be used against P. aeruginosa; inhalatory tobramycin frequency of administration is twice daily and inhalation time is estimated to be 15 to 20 min...
2017: Multidisciplinary Respiratory Medicine
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