Aztreonam (for inhalation solution) for the treatment of chronic lung infections in patients with cystic fibrosis: an evidence-based review

Stephen Kirkby1, Kimberly Novak2, Karen McCoy11Section of Pulmonary Medicine, Nationwide Children's Hospital, 2Department of Pharmacy, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USAAbstract: Cystic fibrosis (CF) is a genetic disease caused by abnormal chloride transport across cellular membranes. In the respiratory tract, this molecular defect causes obstruction of the airways by mucus and chronic endobronchial infection. The majority of patients suffer early death from chronic respiratory disease. Pseudomonas aeruginosa is the predominant chronic airway pathogen in older children and adults with CF and is associated with worse outcomes. However, overall survival in CF has been greatly improved in recent decades due in large part to the aggressive treatment of chronic infections such as P. aeruginosa. While intravenous and oral antibiotics are commonly used in the management of CF respiratory infections, inhaled anti-infective therapies offer the benefit of delivering the drug directly to the site of infection and avoiding potential toxicities associated with systemic absorption. Aztreonam lysine (AZLI) has recently been developed as an inhaled antibiotic for chronic use in CF patients with endobronchial P. aeruginosa infection. This paper reviews background data and the clinical studies which contributed to AZLI's formal FDA approval and growing role in the management of CF pulmonary disease.Keywords: cystic fibrosis, aztreonam lysine, Pseudomonas aeruginosa, inhaled antibiotics