Cochrane · systematic review · CD001021
Inhaled anti‐pseudomonal antibiotics for long‐term therapy in cystic fibrosis
Smith, S, Rowbotham, NJ · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
56
current version
GRADE rated
43
No studies
13
Included studies
NR
No studies 13 · 23.2%Ungraded 0 · 0%Very low 3 · 5.4%Low 19 · 33.9%Moderate 16 · 28.6%High 5 · 8.9%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Show all 2 versionsSummary of findings: anti‐pseudomonal antibiotics versus placebo
Population: adults and children with CF and P aeruginosa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1 (% predicted) Summary of findings: anti‐pseudomonal antibiotics vs placebo | no estimate extracted | 11 studies · 1130 participants | Low Downgraded: risk of bias |
FVC (% predicted) Summary of findings: anti‐pseudomonal antibiotics vs placebo | no estimate extracted | 10 studies · 1097 participants | Low Downgraded: risk of bias |
Pulmonary exacerbations: frequency of one or more hospital admissions Summary of findings: anti‐pseudomonal antibiotics vs placebo | RR 0.66 [0.47, 0.93] | 3 studies · 946 participants | Low Downgraded: risk of bias |
Quality of life: lost school or working days Summary of findings: anti‐pseudomonal antibiotics vs placebo | no estimate extracted | 1 study · 245 participants | Low Downgraded: risk of bias, imprecision |
Survival: number of deaths Summary of findings: anti‐pseudomonal antibiotics vs placebo | RR 0.17 [0.03, 1.09] | 2 studies · 767 participants | Low Downgraded: risk of bias, imprecision |
Antibiotic resistance: frequency of tobramycin‐resistant P aeruginosa Summary of findings: anti‐pseudomonal antibiotics vs placebo | RR 1.95 [0.86, 4.42] | 2 studies · 672 participants | Moderate Downgraded: risk of bias |
Adverse events Summary of findings: anti‐pseudomonal antibiotics vs placebo | no estimate extracted | 6 studies · 1014 participants | Very low Downgraded: risk of bias, imprecision |
Summary of findings: colistimethate dry powder for inhalation (Colobreathe®) versus tobramycin for inhalation solution
Population: children and adults with CF and P aeruginosa infection
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1 (% predicted): mean change from baseline Summary of findings: colistimethate dry powder for inhalation (Colobreathe®) vs tobramycin | no estimate extracted | 1 study · 374 participants | Low Downgraded: risk of bias |
FVC (% predicted): mean change from baseline Summary of findings: colistimethate dry powder for inhalation (Colobreathe®) vs tobramycin | no estimate extracted | 1 study · 374 participants | Low Downgraded: risk of bias |
Pulmonary exacerbations: number of pulmonary exacerbations Summary of findings: colistimethate dry powder for inhalation (Colobreathe®) vs tobramycin | RR 1.19 [0.86, 1.64] | 1 study · 374 participants | Moderate Downgraded: risk of bias |
Quality of life: adjusted mean change in CFQ‐R score at the end of treatment Summary of findings: colistimethate dry powder for inhalation (Colobreathe®) vs tobramycin | no estimate extracted | 1 study · 374 participants | Low Downgraded: risk of bias, imprecision |
Survival: number of deaths Summary of findings: colistimethate dry powder for inhalation (Colobreathe®) vs tobramycin | RR 0.21 [0.01, 4.32] | 1 study · 374 participants | Low Downgraded: risk of bias, imprecision |
Antibiotic resistance: change in mean MIC50 and MIC90 at the end of the trial Summary of findings: colistimethate dry powder for inhalation (Colobreathe®) vs tobramycin | no estimate extracted | 1 study · 374 participants | Low Downgraded: risk of bias, imprecision |
Adverse events: number of treatment related adverse events Summary of findings: colistimethate dry powder for inhalation (Colobreathe®) vs tobramycin | RR 1.76 [1.5, 2.08] | 1 study · 379 participants | Low Downgraded: risk of bias, imprecision |
Summary of findings: inhaled TOBI® (IV preparation) versus tobramycin for inhalation solution
Population: adults and children with CF and P aeruginosa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1 (% predicted): change from baseline Summary of findings: inhaled TOBI® (IV preparation) vs tobramycin | no estimate extracted | 1 study · 32 participants | Very low Downgraded: risk of bias, imprecision |
FVC (% predicted): change from baseline Summary of findings: inhaled TOBI® (IV preparation) vs tobramycin | no estimate extracted | 1 study · 32 participants | Very low Downgraded: risk of bias, imprecision |
Pulmonary exacerbations Summary of findings: inhaled TOBI® (IV preparation) vs tobramycin | no estimate extracted | NR | No studies |
Quality of life Summary of findings: inhaled TOBI® (IV preparation) vs tobramycin | no estimate extracted | NR | No studies |
Survival Summary of findings: inhaled TOBI® (IV preparation) vs tobramycin | no estimate extracted | NR | No studies |
Antibiotic resistance Summary of findings: inhaled TOBI® (IV preparation) vs tobramycin | no estimate extracted | NR | No studies |
Adverse events Summary of findings: inhaled TOBI® (IV preparation) vs tobramycin | no estimate extracted | NR | No studies |
Summary of findings: tobramycin for inhalation powder versus tobramycin for inhalation solution
Population: children and adults with CF and P aeruginosa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1 (% predicted): relative change from baseline Summary of findings: tobramycin for inhalation powder vs tobramycin | no estimate extracted | 1 study · 517 participants | Moderate Downgraded: risk of bias |
FVC Summary of findings: tobramycin for inhalation powder vs tobramycin | no estimate extracted | NR | No studies |
Pulmonary exacerbations: number of participants experiencing pulmonary exacerbation Summary of findings: tobramycin for inhalation powder vs tobramycin | RR 1.12 [0.86, 1.45] | 1 study · 517 participants | Moderate Downgraded: risk of bias |
Quality of life Summary of findings: tobramycin for inhalation powder vs tobramycin | no estimate extracted | NR | No studies |
Survival: number of deaths Summary of findings: tobramycin for inhalation powder vs tobramycin | 4.76 [0.25, 91.62] | 1 study · 517 participants | Low Downgraded: risk of bias, imprecision |
Antibiotic resistance: mean change from baseline in P aeruginosa sputum density Summary of findings: tobramycin for inhalation powder vs tobramycin | no estimate extracted | 1 study · 517 participants | Moderate Downgraded: risk of bias |
Adverse events: number of any adverse event reported Summary of findings: tobramycin for inhalation powder vs tobramycin | RR 1.07 [1, 1.15] | 1 study · 517 participants | Moderate Downgraded: risk of bias |
Summary of findings: aztreonam lysine for inhalation versus tobramycin for inhalation solution
Population: children and adults with CF and P aeruginosa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1 (% predicted): mean relative change from baseline averaged across 3 cycles Summary of findings: aztreonam lysine for inhalation vs tobramycin | no estimate extracted | 1 study · 268 participants | Moderate Downgraded: risk of bias |
FVC Summary of findings: aztreonam lysine for inhalation vs tobramycin | no estimate extracted | NR | No studies |
Pulmonary exacerbations: need for additional antibiotics Summary of findings: aztreonam lysine for inhalation vs tobramycin | RR 0.66 [0.51, 0.86] | 1 study · 268 participants | Moderate Downgraded: risk of bias |
Quality of life: mean change from baseline in CFQ‐R respiratory symptom scale averaged across 3 cycles Summary of findings: aztreonam lysine for inhalation vs tobramycin | no estimate extracted | 1 study · 268 participants | Moderate Downgraded: risk of bias |
Survival Summary of findings: aztreonam lysine for inhalation vs tobramycin | no estimate extracted | 1 study · 268 participants | Low Downgraded: risk of bias, imprecision |
Antibiotic resistance: change from baseline in P aeruginosa CFU/g of sputum at week 24 Summary of findings: aztreonam lysine for inhalation vs tobramycin | no estimate extracted | 1 study · 268 participants | Moderate Downgraded: risk of bias |
Adverse events: number of treatment‐related adverse events Summary of findings: aztreonam lysine for inhalation vs tobramycin | RR 1.77 [1.03, 3.04] | 1 study · 268 participants | Moderate Downgraded: risk of bias |
Summary of findings: amikacin liposome inhalation suspension (ALIS) versus tobramycin for inhalation solution
Population: children and adults with CF and P aeruginosa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1: LS mean FEV1 (L) Summary of findings: amikacin liposome inhalation suspension (ALIS) vs tobramycin | no estimate extracted | 1 study · 262 participants | Moderate Downgraded: risk of bias |
FVC Summary of findings: amikacin liposome inhalation suspension (ALIS) vs tobramycin | no estimate extracted | NR | No studies |
Pulmonary exacerbations: frequency of pulmonary exacerbations Summary of findings: amikacin liposome inhalation suspension (ALIS) vs tobramycin | no estimate extracted | 1 study · 294 participants | Moderate Downgraded: risk of bias |
Quality of life: change in CFQ‐R domain scores (mean CFQ‐R score) Summary of findings: amikacin liposome inhalation suspension (ALIS) vs tobramycin | no estimate extracted | 1 study · 294 participants | Moderate Downgraded: risk of bias |
Survival Summary of findings: amikacin liposome inhalation suspension (ALIS) vs tobramycin | no estimate extracted | NR | No studies |
Antibiotic resistance: change from baseline in P aeruginosa CFU/g of sputum density Summary of findings: amikacin liposome inhalation suspension (ALIS) vs tobramycin | no estimate extracted | 1 study · 259 participants | Moderate Downgraded: risk of bias |
Adverse events: number of participants experiencing any TEAE Summary of findings: amikacin liposome inhalation suspension (ALIS) vs tobramycin | RR 1.47 [0.81, 2.66] | 1 study · 294 participants | Moderate Downgraded: risk of bias |
Summary of findings: levofloxacin for inhalation solution versus tobramycin for inhalation solution
Population: adults and children aged over 12 with CF and P aeruginosa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1 (% predicted): relative mean change from baseline Summary of findings: levofloxacin for inhalation solution vs tobramycin | no estimate extracted | 1 study · 282 participants | High |
FVC(% predicted): relative mean change from baseline Summary of findings: levofloxacin for inhalation solution vs tobramycin | no estimate extracted | 1 study · 282 participants | High |
Pulmonary exacerbations: number of hospitalisations due to respiratory exacerbations Summary of findings: levofloxacin for inhalation solution vs tobramycin | RR 0.62 [0.4, 0.98] | 1 study · 282 participants | High |
Quality of life: change from baseline in CFQ‐R Summary of findings: levofloxacin for inhalation solution vs tobramycin | no estimate extracted | 1 study · 282 participants | Low Downgraded: indirectness, publication bias |
Survival Summary of findings: levofloxacin for inhalation solution vs tobramycin | no estimate extracted | NR | No studies |
Antibiotic resistance: mean change in P aeruginosa sputum density (log10 CFU/g) Summary of findings: levofloxacin for inhalation solution vs tobramycin | no estimate extracted | 1 study · 282 participants | High |
Adverse events: number of treatment‐related adverse events Summary of findings: levofloxacin for inhalation solution vs tobramycin | no estimate extracted | 1 study · 282 participants | High |
Summary of findings: continuous cycles alternating aztreonam lysine for inhalation with tobramycin for inhalation solution versus continuous cycles alternating placebo with tobramycin for inhalation solution
Population: children and adults with CF and P aeruginosa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
FEV1 (% predicted): mean change from baseline (average values across the end of the 3 treatment cycles) Summary of findings: continuous cycles alternating aztreonam lysine for inhalation with tobramycin for inhalation solution vs continuous cycles alternating placebo with tobramycin | no estimate extracted | 1 study · 90 participants | Low Downgraded: risk of bias, imprecision |
FVC Summary of findings: continuous cycles alternating aztreonam lysine for inhalation with tobramycin for inhalation solution vs continuous cycles alternating placebo with tobramycin | no estimate extracted | NR | No studies |
Pulmonary exacerbations: rate of PDEs per participant year Summary of findings: continuous cycles alternating aztreonam lysine for inhalation with tobramycin for inhalation solution vs continuous cycles alternating placebo with tobramycin | RR 0.71 [0.43, 1.18] | 1 study · 90 participants | Low Downgraded: risk of bias, imprecision |
Quality of life: CFQ‐R respiratory symptom scores averaged from weeks 4, 12 and 20 Summary of findings: continuous cycles alternating aztreonam lysine for inhalation with tobramycin for inhalation solution vs continuous cycles alternating placebo with tobramycin | no estimate extracted | 1 study · 90 participants | Low Downgraded: risk of bias, imprecision |
Survival Summary of findings: continuous cycles alternating aztreonam lysine for inhalation with tobramycin for inhalation solution vs continuous cycles alternating placebo with tobramycin | no estimate extracted | NR | No studies |
Antibiotic resistance: mean change from baseline in Paeruginosa sputum density (CFU/g) Summary of findings: continuous cycles alternating aztreonam lysine for inhalation with tobramycin for inhalation solution vs continuous cycles alternating placebo with tobramycin | no estimate extracted | 1 study · 87 participants | Low Downgraded: risk of bias, imprecision |
Adverse events: any adverse event in the comparative phase Summary of findings: continuous cycles alternating aztreonam lysine for inhalation with tobramycin for inhalation solution vs continuous cycles alternating placebo with tobramycin | RR 0.97 [0.9, 1.05] | 1 study · 88 participants | Low Downgraded: risk of bias, imprecision |