Cochrane · systematic review · CD004197
Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis
Langton Hewer, SC, Smith, S, Rowbotham, NJ, et al. · Cochrane Database of Systematic Reviews · 2023 · 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
70
current version
GRADE rated
43
No studies
27
Included studies
NR
No studies 27 · 38.6%Ungraded 0 · 0%Very low 16 · 22.9%Low 7 · 10%Moderate 15 · 21.4%High 5 · 7.1%
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 versionsInhaled tobramycin (TNS) compared with placebo
Population: adults and children with cystic fibrosis and a positive microbiological isolate of Pseudomonas aeruginosa from a respiratory tract specimen
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: proportion with positive respiratory culture for P aeruginosa Inhaled tobramycin (TNS) vs placebo | OR 0.06 [0.02, 0.18] | 3 studies · 89 participants | Low Downgraded: risk of bias, indirectness |
FEV1 Inhaled tobramycin (TNS) vs placebo | no estimate extracted | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FVC Inhaled tobramycin (TNS) vs placebo | no estimate extracted | 1 study · 22 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Growth and nutritional status: change in weight (kg) from baseline Inhaled tobramycin (TNS) vs placebo | no estimate extracted | NR | No studies |
Frequency of infective pulmonary exacerbations: number of exacerbations per patient year Inhaled tobramycin (TNS) vs placebo | no estimate extracted | NR | No studies |
Isolation of other micro‐organisms from the respiratory tract: number of positive cultures per patient year Inhaled tobramycin (TNS) vs placebo | no estimate extracted | NR | No studies |
Adverse effects of antibiotics: participants experiencing cough Inhaled tobramycin (TNS) vs placebo | OR 0.76 [0.1, 5.77] | 2 studies · 72 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Inhaled tobramycin (TNS) (28 days) compared with TNS (56 days)
Population: adults and children with cystic fibrosis and a positive microbiological isolate of P aeruginosa from a respiratory tract specimen
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: time to next isolation of P aeruginosa from BAL, sputum or oropharyngeal cultures Inhaled tobramycin (TNS) (28 days) vs TNS (56 days) | no estimate extracted | NR | No studies |
FEV1: % predicted Inhaled tobramycin (TNS) (28 days) vs TNS (56 days) | no estimate extracted | 1 study · 88 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FVC: % predicted Inhaled tobramycin (TNS) (28 days) vs TNS (56 days) | no estimate extracted | 1 study · 88 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Growth and nutritional status: weight, height and BMI Inhaled tobramycin (TNS) (28 days) vs TNS (56 days) | no estimate extracted | 1 study · 88 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Frequency of infective pulmonary exacerbations: number of exacerbations per patient year Inhaled tobramycin (TNS) (28 days) vs TNS (56 days) | OR 0.19 [0.01, 4] | 1 study · 77 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Isolation of other micro‐organisms from the respiratory tract: number of positive cultures per patient year Inhaled tobramycin (TNS) (28 days) vs TNS (56 days) | no estimate extracted | 1 study · 88 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Adverse effects of antibiotics Inhaled tobramycin (TNS) (28 days) vs TNS (56 days) | no estimate extracted | 1 study · 77 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Cycled inhaled tobramycin (TNS) compared to culture‐based TNS
Population: adults and children with cystic fibrosis and a positive microbiological isolate of P aeruginosa from a respiratory tract specimen
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: proportion of participants with one or more isolates of P aeruginosa from the respiratory tract Cycled inhaled tobramycin (TNS) vs culture‐based TNS | no estimate extracted | NR | No studies |
FEV1: mean 70‐week % change in FEV1 (% predicted) Cycled inhaled tobramycin (TNS) vs culture‐based TNS | no estimate extracted | 1 study · 143 participants | Low Downgraded: indirectness |
FVC Cycled inhaled tobramycin (TNS) vs culture‐based TNS | no estimate extracted | NR | No studies |
Growth and nutritional status: mean 70‐week change from baseline in weight (kg) and height (cm) Cycled inhaled tobramycin (TNS) vs culture‐based TNS | no estimate extracted | 1 study · 304 participants | Moderate Downgraded: indirectness |
Frequency of infective pulmonary exacerbations: proportion of participants with one or more pulmonary exacerbations (any severity) Cycled inhaled tobramycin (TNS) vs culture‐based TNS | OR 0.75 | 1 study · 304 participants | Moderate Downgraded: indirectness |
Isolation of other micro‐organisms from the respiratory tract: proportion of participants with new isolates of Stenotrophomonas maltophilia Cycled inhaled tobramycin (TNS) vs culture‐based TNS | OR 1.18 [0.65, 2.12] | 1 study · 279 participants | Moderate Downgraded: indirectness |
Adverse effects of antibiotics: proportion of participants with one or more serious adverse events Cycled inhaled tobramycin (TNS) vs culture‐based TNS | OR 0.85 | 1 study · 304 participants | Moderate Downgraded: indirectness |
Ciprofloxacin compared to placebo added to cycled and culture‐based inhaled tobramycin (TNS) therapy
Population: adults and children with cystic fibrosis and a positive microbiological isolate of P aeruginosa from a respiratory tract specimen
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: proportion of participants with one or more isolates of P aeruginosa from the respiratory tract Ciprofloxacin vs placebo added to cycled and culture‐based inhaled tobramycin (TNS) therapy | no estimate extracted | NR | No studies |
FEV1: mean 70‐week % change in FEV1 (% predicted) Ciprofloxacin vs placebo added to cycled and culture‐based inhaled tobramycin (TNS) therapy | no estimate extracted | 1 study · 143 participants | Low Downgraded: indirectness |
FVC Ciprofloxacin vs placebo added to cycled and culture‐based inhaled tobramycin (TNS) therapy | no estimate extracted | NR | No studies |
Growth and nutritional status: mean 70‐week change from baseline in weight (kg) and height (cm) Ciprofloxacin vs placebo added to cycled and culture‐based inhaled tobramycin (TNS) therapy | no estimate extracted | 1 study · 304 participants | Moderate Downgraded: indirectness |
Frequency of infective pulmonary exacerbations: proportion of participants with one or more pulmonary exacerbations (any severity) Ciprofloxacin vs placebo added to cycled and culture‐based inhaled tobramycin (TNS) therapy | OR 1.49 [0.95, 2.33] | 1 study · 304 participants | Moderate Downgraded: indirectness |
Isolation of other micro‐organisms from the respiratory tract: proportion of participants with new isolates of Stenotrophomonas maltophilia Ciprofloxacin vs placebo added to cycled and culture‐based inhaled tobramycin (TNS) therapy | OR 1.2 [0.66, 2.16] | 1 study · 279 participants | Moderate Downgraded: indirectness |
Adverse effects of antibiotics: proportion of participants with one or more serious adverse event Ciprofloxacin vs placebo added to cycled and culture‐based inhaled tobramycin (TNS) therapy | OR 1.54 [0.93, 2.57] | 1 study · 304 participants | Moderate Downgraded: indirectness |
Oral ciprofloxacin and inhaled colistin compared to inhaled tobramycin (TNS)
Population: adults and children with cystic fibrosis and a positive microbiological isolate of P aeruginosa from a respiratory tract specimen
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: proportion with positive respiratory culture for P aeruginosa Oral ciprofloxacin and inhaled colistin vs inhaled tobramycin (TNS) | OR 0.43 [0.15, 1.23] | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FEV1: change from baseline (% predicted) Oral ciprofloxacin and inhaled colistin vs inhaled tobramycin (TNS) | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FVC Oral ciprofloxacin and inhaled colistin vs inhaled tobramycin (TNS) | no estimate extracted | NR | No studies |
Growth and nutritional status: BMI and weight z score Oral ciprofloxacin and inhaled colistin vs inhaled tobramycin (TNS) | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Frequency of infective pulmonary exacerbations: number of exacerbations per patient year Oral ciprofloxacin and inhaled colistin vs inhaled tobramycin (TNS) | no estimate extracted | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Isolation of other micro‐organisms from the respiratory tract: number of positive cultures per patient year Oral ciprofloxacin and inhaled colistin vs inhaled tobramycin (TNS) | no estimate extracted | NR | No studies |
Adverse effects of antibiotics: severe cough Oral ciprofloxacin and inhaled colistin vs inhaled tobramycin (TNS) | OR 0.32 [0.01, 8.24] | 1 study · 58 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Inhaled colistin plus oral ciprofloxacin compared to inhaled tobramycin (TNS) plus oral ciprofloxacin
Population: adults and children with cystic fibrosis and a positive microbiological isolate of P aeruginosa from a respiratory tract specimen
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: proportion with positive respiratory culture for P aeruginosa Inhaled colistin plus oral ciprofloxacin vs inhaled tobramycin (TNS) plus oral ciprofloxacin | OR 1.11 [0.64, 1.92] | 1 study · 223 participants | Low Downgraded: risk of bias, imprecision |
FEV1: relative change in % predicted FEV1 from baseline Inhaled colistin plus oral ciprofloxacin vs inhaled tobramycin (TNS) plus oral ciprofloxacin | no estimate extracted | NR | No studies |
FVC Inhaled colistin plus oral ciprofloxacin vs inhaled tobramycin (TNS) plus oral ciprofloxacin | no estimate extracted | NR | No studies |
Growth and nutritional status Inhaled colistin plus oral ciprofloxacin vs inhaled tobramycin (TNS) plus oral ciprofloxacin | no estimate extracted | NR | No studies |
Frequency of infective pulmonary exacerbations: number of exacerbations per patient year Inhaled colistin plus oral ciprofloxacin vs inhaled tobramycin (TNS) plus oral ciprofloxacin | no estimate extracted | NR | No studies |
Isolation of other micro‐organisms from the respiratory tract: number of positive cultures per patient year Inhaled colistin plus oral ciprofloxacin vs inhaled tobramycin (TNS) plus oral ciprofloxacin | no estimate extracted | 1 study · 205 participants | Moderate Downgraded: risk of bias |
Adverse effects of antibiotics: leading to trial discontinuation Inhaled colistin plus oral ciprofloxacin vs inhaled tobramycin (TNS) plus oral ciprofloxacin | no estimate extracted | 1 study · 223 participants | Moderate Downgraded: risk of bias |
Inhaled tobramycin (TNS) plus oral azithromycin compared to TNS plus oral placebo
Population: children with cystic fibrosis and a new culture positive for P aeruginosa
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: number of participants eradicated after three month treatment phase Inhaled tobramycin (TNS) plus oral azithromycin vs TNS plus oral placebo | RR 1.01 [0.75, 1.35] | 1 study · 91 participants | Low Downgraded: imprecision, indirectness |
FEV1: mean change in FEV1 % predicted Inhaled tobramycin (TNS) plus oral azithromycin vs TNS plus oral placebo | no estimate extracted | 1 study · 132 participants | Low Downgraded: imprecision, indirectness |
FVC: mean change in FVC % predicted Inhaled tobramycin (TNS) plus oral azithromycin vs TNS plus oral placebo | no estimate extracted | 18 participants | Low Downgraded: imprecision, indirectness |
Growth and nutritional status: mean change in weight (kg) from baseline Inhaled tobramycin (TNS) plus oral azithromycin vs TNS plus oral placebo | no estimate extracted | 1 study · 221 participants | Moderate Downgraded: indirectness |
Frequency of infective pulmonary exacerbations: number of participants experiencing an exacerbation by the end of the study Inhaled tobramycin (TNS) plus oral azithromycin vs TNS plus oral placebo | RR 0.75 [0.56, 1] | 1 study · 221 participants | Moderate Downgraded: indirectness |
Isolation of other micro‐organisms from the respiratory tract: number of participants with a positive result for other organisms. Inhaled tobramycin (TNS) plus oral azithromycin vs TNS plus oral placebo | no estimate extracted | 1 study · 221 participants | Moderate Downgraded: indirectness |
Adverse effects of antibiotics: number of participants experiencing any adverse event Inhaled tobramycin (TNS) plus oral azithromycin vs TNS plus oral placebo | RR 1.05 [0.96, 1.14] | 1 study · 221 participants | Moderate Downgraded: indirectness |
Oral ciprofloxacin and inhaled colistin compared with no treatment
Population: adults and children with cystic fibrosis and a positive microbiological isolate of P aeruginosa from a respiratory tract specimen
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract Oral ciprofloxacin and inhaled colistin vs no treatment | no estimate extracted | NR | No studies |
FEV1 Oral ciprofloxacin and inhaled colistin vs no treatment | no estimate extracted | NR | No studies |
FVC Oral ciprofloxacin and inhaled colistin vs no treatment | no estimate extracted | NR | No studies |
Growth and nutritional status Oral ciprofloxacin and inhaled colistin vs no treatment | no estimate extracted | NR | No studies |
Frequency of infective pulmonary exacerbations: number of exacerbations per patient year Oral ciprofloxacin and inhaled colistin vs no treatment | no estimate extracted | NR | No studies |
Isolation of other micro‐organisms from the respiratory tract: number of positive cultures per patient year Oral ciprofloxacin and inhaled colistin vs no treatment | no estimate extracted | NR | No studies |
Adverse effects of antibiotics Oral ciprofloxacin and inhaled colistin vs no treatment | no estimate extracted | 1 study · 26 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
14 days inhaled AZLI plus 14 days placebo compared to 28 days inhaled AZLI
Population: children and adolescents with cystic fibrosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: proportion of participants with a negative culture for PA during the 28 days following treatment 14 days inhaled AZLI plus 14 days placebo vs 28 days inhaled AZLI | no estimate extracted | 1 study · 139 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
FEV1 % predicted 14 days inhaled AZLI plus 14 days placebo vs 28 days inhaled AZLI | no estimate extracted | NR | No studies |
FVC % predicted 14 days inhaled AZLI plus 14 days placebo vs 28 days inhaled AZLI | no estimate extracted | NR | No studies |
Growth and nutritional status 14 days inhaled AZLI plus 14 days placebo vs 28 days inhaled AZLI | no estimate extracted | NR | No studies |
Frequency of infective pulmonary exacerbations 14 days inhaled AZLI plus 14 days placebo vs 28 days inhaled AZLI | no estimate extracted | NR | No studies |
Isolation of other micro‐organisms from the respiratory tract 14 days inhaled AZLI plus 14 days placebo vs 28 days inhaled AZLI | no estimate extracted | NR | No studies |
Adverse effects of antibiotics: number of participants reporting a serious adverse event 14 days inhaled AZLI plus 14 days placebo vs 28 days inhaled AZLI | no estimate extracted | NR | No studies |
Intravenous ceftazidime with tobramycin compared with oral ciprofloxacin
Population: adults and children with cystic fibrosis and a positive microbiological isolate of Pseudomonas aeruginosa from a respiratory tract specimen
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Eradication of P aeruginosa from the respiratory tract: number of participants testing negative for P aeruginosa at 3 months and remaining free until 15 months Intravenous ceftazidime with tobramycin vs oral ciprofloxacin | no estimate extracted | NR | No studies |
FEV1: mean FEV1 % predicted Intravenous ceftazidime with tobramycin vs oral ciprofloxacin | no estimate extracted | 1 study · 285 participants | High |
FVC: mean FVC % predicted Intravenous ceftazidime with tobramycin vs oral ciprofloxacin | no estimate extracted | 1 study · 285 participants | High |
Growth and nutritional status: weight‐for‐age z score Intravenous ceftazidime with tobramycin vs oral ciprofloxacin | no estimate extracted | 1 study · 285 participants | High |
Frequency of infective pulmonary exacerbations: number of participants experiencing an exacerbation Intravenous ceftazidime with tobramycin vs oral ciprofloxacin | RR 0.78 [0.55, 1.1] | 1 study · 285 participants | High |
Isolation of other micro‐organisms from the respiratory tract: number of participants isolating other micro‐organisms within the 15‐month Intravenous ceftazidime with tobramycin vs oral ciprofloxacin | RR 2.07 | 1 study · 285 participants | High |
Adverse effects of antibiotics: Intravenous ceftazidime with tobramycin vs oral ciprofloxacin | RR 0.97 | 1 study · 285 participants | Moderate Downgraded: risk of bias |