Résumé
Once daily tobramycin is convenient to use and achieves higher tissue levels that should kill Pseudomonas aeruginosa more rapidly. Small trials of OD compared with TDS aminoglycosides in CF patients have shown no difference in efficacy or toxicity. No one has looked in detail at the impact on sputum microbiology. In a prospective, randomized study at Papworth Hospital, UK, we compared OD with TDS tobramycin, each plus a second anti-pseudomonal, for the treatment of acute infective exacerbation in 15 adult cystic fibrosis patients colonized with Pseudomonas aeruginosa. Using the patients as their own control, the same individuals received the alternate treatment regime for the next exacerbation. We aimed to compare the clinical and bacteriological efficacy, toxicity, and the effects on susceptibility of the organism among patients in both treatment groups. Isolates were identified, and the Minimum Inhibitory Concentration [MIC] of the antibiotic in each patient was performed. Patients were assessed for clinical improvement, toxicity and the total viable count in their sputum on days 0, 7 and 14. In both treatment groups there was a significant clinical improvement, and toxicity did not occur in either group. There was no difference in clinical outcome, adverse events, or time to the next exacerbation. No difference was seen in the selection of antibiotic resistance. OD tobramycin appeared more effective in reducing the number of bacteria in the group overall at day 7 and in two individuals, at day 14