Inhaled antimicrobial prescribing for Pseudomonas aeruginosa infections in Europe

Callum Sloan, Laura Sherrard, Gisli Einarsson, Lieven Dupont, Silke van Koningsbruggen-Rietschel, Nicholas Simmonds, Damian Downey*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Prescribers have an increasing range of inhaled antimicrobial formulations to choose from when prescribing both eradication and chronic suppression regimens in cystic fibrosis (CF). This study aimed to investigate the decision-making process behind prescribing of inhaled antimicrobials for Pseudomonas aeruginosa infections.
Methods
A questionnaire was developed using Microsoft Forms and then forwarded to 57 Principal Investigators (PIs), at each of the CF centres within the European Cystic Fibrosis Society-Clinical Trials Network (ECFS-CTN). Data collection occurred between November 2021 and February 2022.
Results
The response rate was 90 % (n = 51/57 PIs), with at least 50 % of CF centers in each of the 17 countries represented in the ECFS-CTN. Physicians used a median of eight factors in their decision-making process with delivery formulations (92.2 %), adherence history (84.3 %), and antibiotic side-effect profile (76.5 %) often selected. Nebulised tobramycin or colistin were frequently selected as the inhaled antimicrobial in first-line eradication (n = 45, 88.2 %) and chronic suppression regimens (n = 42, 82.4 %). Combination regimens were more often chosen in eradication (first-line: n = 35, 68.6 %, second-line: n = 34, 66.7 %) and later chronic suppression regimens (third-line: n = 27, 52.9 %) than monotherapy. For pwCF also prescribed CFTR modulator therapies, most PIs did not alter inhaled antimicrobial regimens (n = 40, 78.4 %), with few pwCF (n = 18, 35.3 %) or PIs (n = 10, 19.6 %) deciding to stop inhaled antimicrobials.
Conclusions
The inhaled antimicrobial prescribing decision-making process is multifactorial. Nebulised tobramycin or colistin are often used in initial eradication and chronic suppression regimens. To date, CFTR modulator therapy has had a limited impact on the prescribing of inhaled antimicrobial regimens.
Original languageEnglish
JournalJournal of Cystic Fibrosis
Early online date14 Feb 2024
DOIs
Publication statusEarly online date - 14 Feb 2024

Bibliographical note

Funding Information:
This study was completed as part of a PhD project funded by Chiesi. Chiesi had no role in the study design, the collection, analysis and interpretation of data, or in the writing of the report and decision to publish.

Publisher Copyright:
© 2023

Keywords

  • pseudomonas aeruginosa
  • inhaled antibiotics
  • Cystic fibrosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

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