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Canadian Respiratory Journal
Volume 14 (2007), Issue 8, Pages 473-479
http://dx.doi.org/10.1155/2007/673976
Original Article

Comparative Efficacy of Two Doses of Nebulized Colistimethate for the Eradication of Pseudomonas Aeruginosa in Children with Cystic Fibrosis

Marie-Sophie Brochet,1 Anne-Catherine McDuff,1 Jean-François Bussières,1 Elaine Caron,1 Geneviève Fortin,1 Denis Lebel,1 and Jacques-Édouard Marcotte2

1Department of Pharmacy, CHU Sainte-Justine, Montreal, Quebec, Canada
2Department of Pneumology, CHU Sainte-Justine, Montreal, Quebec, Canada

Copyright © 2007 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Cystic fibrosis (CF) affects the respiratory and digestive systems. It evolves toward deterioration of pulmonary function through colonization with Pseudomonas aeruginosa. There is no consensus with respect to its eradication. Nebulized colistimethate is used for eradication treatment, but the optimal dose and duration is yet to be determined.

OBJECTIVES: To compare the efficacy of two doses of nebulized colistimethate (30 mg versus 75 mg twice daily) for the eradication of P aeruginosa in children with CF and intermittent colonization.

METHODS: A cohort study with both historical (30 mg) and prospective (75 mg) arms was conducted from 1999 to 2003. Medical records were used to collect data.

RESULTS: Eighty-one patients were recruited in the retrospective group, for a total of 111 treatment courses. Twenty patients were recruited in the prospective group, for a total of 20 events. There was no statistically significant difference in the rate of eradication of P aeruginosa at days 28 and 90, neither when comparing the doses of colistimethate nor duration of treatment. There was a statistically significant difference (P=0.004) between days 1 and 90 in all analyzed subgroups (regardless of dose or duration of treatment) for forced vital capacity only. In the group of patients in whom eradication was achieved at day 28 (after receiving a three-week treatment course of colistimethate), 50% of patients developed a new infection 5.75 months later, on average, regardless of the dose administered. In the group of patients who achieved eradication at day 90 (after receiving a 15-week treatment course of colistimethate), 50% of the 14 patients developed a new infection after an average period of 7.3 months (P=0.28).

CONCLUSIONS: There is no difference in the efficacy between a 30 mg dose and a 75 mg dose of colistimethate for P aeruginosa eradication in children with CF and intermittent colonization.