Evaluation of controlled intravenous infusions of aminoglycoside antibiotics in outpatients with cystic fibrosis

Once an infection has begun to resolve and a patient no longer requires hospitalization, except to complete a course of antibiotic therapy, continued antibiotic therapy at home should be considered. However, patients are often required to remain in the hospital because their antibiotics must be administered parenterally for therapeutic reasons of lack of an oral dosage form. This is often the case for patients with cystic fibrosis being treated for pulmonary exacerbations of the disease. Cystic fibrosis, transmitted as an autosomal recessive trait, is a disease of the exocrine glands. Pulmonary involvement is one of the clinical hallmarks in cystic fibrosis and is responsible for 95 percent of the morbidity and mortality. The viscid mucous secretions favor bacterial growth and three bacterial pathogens are frequently isolated in the sputum: Staphylococcus aureus, Haemophilus influenzae or Pseudomanas aeruginosa. Current treatment of the pulmonary exacerbations in cystic fibrosis caused by pulmonary infection often requires hospital admission for aggressive chest percussion, postural drainage and treatment with intravenous antibiotics. Intravenous antibiotics are generally needed for 10 or more days and usually include an aminoglycoside. Frequently, cystic fibrosis patients respond rapidly to treatment but require prolonged hospitalization in order to complete the full aminoglycoside antibiotic regimen by rate-controlled intravenous infusion. This extended hospital stay results in considerable expense. Outpatient intramuscular injections of aminoglycoside would be an alternative to inpatient administration of the antibiotic but several limitations exist. Outpatient aminoglycoside intravenous treatment would be preferred to intramuscular administration, but requires a safe, ambulatory infusion system which delivers the medication at a controlled rate of infusion. At-home administration of an aminoglycoside antibiotic should lead to decreased hospiptal stay, emotional stress associated with the hospitalization and cost of treating the frequent pulmonary exacerbations of cystic fibrosis.