Background Patients with non-cystic fibrosis (CF) bronchiectasis (BQ) are chronically colonised and infected by bacterial pathogens. The use of inhaled antibiotics in these patients is an increasingly common practice.
Purpose To describe the use of inhaled colistin in patients with non-CF BQ.
Material and methods A retrospective descriptive study in the use of inhaled colistin in non-CF BQ. Adult patients who started treatment between January 2014 to December 2017 were included. The follow-up lasted until April 2018.
Recorded variables were: demographic (age, sex, respiratory history), microbiological (culture at the beginning of treatment, isolated microorganisms and sensitivity), treatment (eradication (yes/no), initial dose, dosage changes or interruptions and cause, concomitant antibiotic treatment) and follow-up (negativisation during therapy, time until culture negativisation).
Results Thirty-three patients with non-CF BQ were included, 24 men and nine women, with a median age of 77 years (51–90). Twenty-nine had a history of pulmonary disease: 18 moderate or severe chronic obstructive pulmonary disease, five pneumonias, two chronic bronchitis and four others.
All patients except one started treatment after sputum culture. The most frequently isolated microorganism was Pseudomonas aeruginosa, whose sensitivity was: 22 multisensitive, three multidrug-resistant (MDR) and six extremely drug-resistant (XDR). Achromobacter xylosoxidans MDR was isolated in two samples and one was negative.
Fifteen performed eradication treatment, all with quinolones: ciprofloxacin (13), levofloxacin (one) and levofloxacin plus imipenem (one).
The most common starting dose was 1 MUI colistin/12 hour. Nine patients had concomitant treatment with azithromycin three times a week.
During the treatment, 15 patients maintained the same dosage, in 10 patients it was modified (three to alternate months, four increased the dose due to lack of effectiveness and three changed to the inhalation exclusive colistin formulation) and in eight it was interrupted (three due to adverse effects, two due to improvement of symptoms, one eradication and two unknown).
The sputum culture of 15 patients became negative during suppressive therapy, with an average time to negativisation of 4 months (1–15 months). Twelve remained on treatment with inhalated colistin despite having negative sputum cultures.
Conclusion The great heterogeneity in the prescription of inhaled colistin makes it necessary to standardise its use and to carry out a treatment protocol in collaboration with the pneumology department.
References and/or acknowledgements No conflict of interest.
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