Document Detail


A randomized controlled trial of nebulized gentamicin in non-cystic fibrosis bronchiectasis.
MedLine Citation:
PMID:  20870753     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: Bronchiectasis is a chronic debilitating disease with few evidence-based long-term treatments.
OBJECTIVES: A randomized controlled trial assessing the efficacy of nebulized gentamicin therapy over 1 year in patients with non-cystic fibrosis bronchiectasis.
METHODS: Sixty-five patients were randomized to either twice-daily nebulized gentamicin, 80 mg, or nebulized 0.9% saline, for 12 months. All were reviewed at three-monthly intervals during treatment and at 3 months' follow-up.
MEASUREMENTS AND MAIN RESULTS: At each review the following were assessed: quantitative and qualitative sputum bacteriology; sputum purulence and 24-hour volume; FEV(1), FVC, and forced expiratory flow, midexpiratory phase; exercise capacity; Leicester Cough Questionnaire and St. George's Respiratory Questionnaire; and exacerbation frequency. Fifty-seven patients completed the study. At the end of 12 months' treatment, compared with the saline group, in the gentamicin group there was reduced sputum bacterial density with 30.8% eradication in those infected with Pseudomonas aeruginosa and 92.8% eradication in those infected with other pathogens; less sputum purulence (8.7% vs. 38.5%; P < 0.0001); greater exercise capacity (510 [350-690] m vs. 415 [267.5-530] m; P = 0.03); and fewer exacerbations (0 [0-1] vs. 1.5 [1-2]; P < 0.0001) with increased time to first exacerbation (120 [87-161.5] d vs. 61.5 [20.7-122.7] d; P = 0.02). The gentamicin group had greater improvements in Leicester Cough Questionnaire (81.4% vs. 20%; P < 0.01) and St. George's Respiratory Questionnaire (87.5% vs. 19.2%; P < 0.004) score. No differences were seen in 24-hour sputum volume, FEV(1), FVC, or forced expiratory flow, midexpiratory phase. No P. aeruginosa isolates developed resistance to gentamicin. At follow-up, all outcome measures were similar to baseline.
CONCLUSIONS: Regular, long-term nebulized gentamicin is of significant benefit in non-cystic fibrosis bronchiectasis but treatment needs to be continuous for its ongoing efficacy. Clinical trial registered with www.clinicaltrials.gov (NCT 00749866).
Authors:
Maeve P Murray; John R W Govan; Catherine J Doherty; A John Simpson; Thomas S Wilkinson; James D Chalmers; Andrew P Greening; Christopher Haslett; Adam T Hill
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-09-24
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  183     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-02-17     Completed Date:  2011-04-05     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  491-9     Citation Subset:  AIM; IM    
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00749866
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MeSH Terms
Descriptor/Qualifier:
Administration, Inhalation
Aerosols
Aged
Anti-Bacterial Agents / administration & dosage*
Bronchiectasis / drug therapy*
Female
Follow-Up Studies
Gentamicins / administration & dosage*
Humans
Male
Middle Aged
Questionnaires
Respiratory Function Tests / methods,  statistics & numerical data
Sodium Chloride / administration & dosage
Treatment Outcome
Grant Support
ID/Acronym/Agency:
CZB/4/451//Chief Scientist Office
Chemical
Reg. No./Substance:
0/Aerosols; 0/Anti-Bacterial Agents; 0/Gentamicins; 7647-14-5/Sodium Chloride
Comments/Corrections
Comment In:
Expert Opin Pharmacother. 2011 May;12(7):1191-4   [PMID:  21470074 ]
Am J Respir Crit Care Med. 2012 Sep 1;186(5):461; author reply 461-2   [PMID:  22942347 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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