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Cystic Fibrosis: Recent Insights into Inhaled Antibiotic Treatment and Future Perspectives

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Cystic Fibrosis Center, Anna Meyer Children’s University Hospital, Viale Pieraccini 24, 50139 Firenze, Italy
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Department Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
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Adult Cystic Fibrosis Center, Azienda Ospedaliera Universitaria San Luigi Gonzaga, 10043 Orbassano, Italy
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Adult Cystic Fibrosis Center, Department of Translational Medical Sciences, Federico II University of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
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Cystic Fibrosis Center, Policlinico Umberto I Hospital, Viale Regina Elena 324, 00161 Rome, Italy
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Cystic Fibrosis Center, Azienda Ospedaliero Universitaria Integrata di Verona, Pl. Aristide Stefani 1, 37126 Verona, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Maria Luisa Mangoni
Antibiotics 2021, 10(3), 338; https://doi.org/10.3390/antibiotics10030338
Received: 5 February 2021 / Revised: 16 March 2021 / Accepted: 17 March 2021 / Published: 22 March 2021
Although new inhaled antibiotics have profoundly improved respiratory diseases in cystic fibrosis (CF) patients, lung infections are still the leading cause of death. Inhaled antibiotics, i.e., colistin, tobramycin, aztreonam lysine and levofloxacin, are used as maintenance treatment for CF patients after the development of chronic Pseudomonas aeruginosa (P. aeruginosa) infection. Their use offers advantages over systemic therapy since a relatively high concentration of the drug is delivered directly to the lung, thus, enhancing the pharmacokinetic/pharmacodynamic parameters and decreasing toxicity. Notably, alternating treatment with inhaled antibiotics represents an important strategy for improving patient outcomes. The prevalence of CF patients receiving continuous inhaled antibiotic regimens with different combinations of the anti-P. aeruginosa antibiotic class has been increasing over time. Moreover, these antimicrobial agents are also used for preventing acute pulmonary exacerbations in CF. In this review, the efficacy and safety of the currently available inhaled antibiotics for lung infection treatment in CF patients are discussed, with a particular focus on strategies for eradicating P. aeruginosa and other pathogens. Moreover, the effects of long-term inhaled antibiotic therapy for chronic P. aeruginosa infection and for the prevention of pulmonary exacerbations is reviewed. Finally, how the mucus environment and microbial community richness can influence the efficacy of aerosolized antimicrobial agents is discussed. View Full-Text
Keywords: cystic fibrosis; P. aeruginosa; inhaled antibiotics; pulmonary exacerbations cystic fibrosis; P. aeruginosa; inhaled antibiotics; pulmonary exacerbations
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MDPI and ACS Style

Taccetti, G.; Francalanci, M.; Pizzamiglio, G.; Messore, B.; Carnovale, V.; Cimino, G.; Cipolli, M. Cystic Fibrosis: Recent Insights into Inhaled Antibiotic Treatment and Future Perspectives. Antibiotics 2021, 10, 338. https://doi.org/10.3390/antibiotics10030338

AMA Style

Taccetti G, Francalanci M, Pizzamiglio G, Messore B, Carnovale V, Cimino G, Cipolli M. Cystic Fibrosis: Recent Insights into Inhaled Antibiotic Treatment and Future Perspectives. Antibiotics. 2021; 10(3):338. https://doi.org/10.3390/antibiotics10030338

Chicago/Turabian Style

Taccetti, Giovanni, Michela Francalanci, Giovanna Pizzamiglio, Barbara Messore, Vincenzo Carnovale, Giuseppe Cimino, and Marco Cipolli. 2021. "Cystic Fibrosis: Recent Insights into Inhaled Antibiotic Treatment and Future Perspectives" Antibiotics 10, no. 3: 338. https://doi.org/10.3390/antibiotics10030338

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