Higher Tobramycin concentration and vibrating mesh technology can shorten antibiotic treatment time in cystic fibrosis

Poor adherence to recommended therapy in cystic fibrosis (CF) is often because of the time demands of therapy. Tobramycin (TOBI ® , 300 mg at 60 mg/ml) inhaled from the PARI LC PLUS ® nebulizer requires about 20 min. This study determined if equivalent levels of pulmonary deposition could be achieved in shorter time using 1.5 ml of 100 mg/ml tobramycin solution delivered by an investigational eFlow ® nebulizer. Sixteen males with stable CF, 8 children and 8 adults, and an FEV 1 > 45% predicted inhaled both preparations on two occasions with 99m Tc-DTPA added to the tobramycin. Blood samples were taken for quantification of tobramycin in the serum. The PARI LC PLUS ® delivered 45.4 (39.3-51.6), mean and 95% CI, mg to the lungs in 17.0 ± 2.5min (mean ± SD) with serum levels of 1,089 ± 388 μg/L. The investigational eFlow ® delivered 46.3(40.3―51.7) mg in 4.0 ± 1.0 min with blood levels of 909 ± 458 μg/L. Only the time of delivery was significantly different with P< 0.0001 (paired t-test). Tolerability of the treatment was comparable for both inhalation regimes, but the shorter treatment was preferred by all patients. These results demonstrate the possibility of delivering equivalent levels of tobramycin much faster into the lungs of CF patients when using eFlow ® , a very efficient electronic nebulizer.