Médecine pulmonaire et respiratoire

Use of Inhaled Tobramycin for the Treatment of Severe Nosocomia Pneumonia

Abstract

Kuzovlev AN, Moroz VV, Goloubev AM, Polovnikov SG, Stec VV and Varvarin VV

Objective: The objective of the study was to estimate the efficacy and safety of Inhaled Tobramycin (IT) as an adjunct to systemic antibiotics in the treatment of severe Nosocomial Pneumonia (NP).

Patients and methods: 25 mechanically ventilated patients (out of 165 screened) were enrolled in the current observational single-center study. They were randomized to receive either IT (300mg, BID; group 1, n=15) as an adjunct to systemic antibiotics or for a correction of the regimen of systemic antibiotics (group 2, n=10). The primary outcome measure was resolution of NP and acute respiratory insufficiency. The CPIS, signs of Systemic Inflammatory Response Syndrome (SIRS) and oxygenation index were used as objective indicators of the clinical progress.

Results: The following signs of IT efficacy were detected in 87% of group 1 patients: a decrease of SIRS and CPIS scores within 2, 3 ± 1, 2 days of IT therapy (p<0,05); decrease of microbes titer to 103-104 CFU/ml (p<0,05); increase of microbes sensitivity to systemic antibiotics in 40% of patients; positive X-ray dynamics in 60% of patients within 9, 0 ± 2, 5 days of IT therapy. No serious side effects of IT were observed.

Conclusion: Administration of IT as an adjunct to systemic antibiotics is efficient and safe in 87% of patients with severe NP caused by multi resistant gram-negative bacteria.