A Randomized Controlled Trial of Nebulized Gentamicin in Non-Cystic Fibrosis Bronchiectasis

Maeve P. Murray, John R. W. Govan, Catherine J. Doherty, A. John Simpson, Thomas S. Wilkinson, James D. Chalmers, Andrew P. Greening, Christopher Haslett, Adam T. Hill

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    Abstract

    Rationale: Bronchiectasis is a chronic debilitating disease with few evidence-based long-term treatments.

    Objectives: A randomized controlled trial assessing the efficacy of nebulized gentamicin therapy over 1 year in patients with non-cystic fibrosis bronchiectasis.

    Methods: Sixty-five patients were randomized to either twice-daily nebulized gentamicin, 80 mg, or nebulized 0.9% saline, for 12 months. All were reviewed at three-monthly intervals during treatment and at 3 months' follow-up.

    Measurements and Main Results: At each review the following were assessed: quantitative and qualitative sputum bacteriology; sputum purulence and 24-hour volume; FEV(1), FVC, and forced expiratory flow, midexpiratory phase; exercise capacity; Leicester Cough Questionnaire and St. George's Respiratory Questionnaire; and exacerbation frequency. Fifty-seven patients completed the study. At the end of 12 months' treatment, compared with the saline group, in the gentamicin group there was reduced sputum bacterial density with 30.8% eradication in those infected with Pseudomonas aeruginosa and 92.8% eradication in those infected with other pathogens; less sputum purulence (8.7% vs. 38.5%; P <0.0001); greater exercise capacity (510 [350-690] m vs. 415 [267.5-530] m; P=0.03); and fewer exacerbations (0 [0-1] vs. 1.5 [1-2]; P

    Conclusions: Regular, long-term nebulized gentamicin is of significant benefit in non-cystic fibrosis bronchiectasis but treatment needs to be continuous for its ongoing efficacy. Clinical trial registered with www.clinicaltrials.gov (NCT 00749866).

    Original languageEnglish
    Pages (from-to)491-499
    Number of pages9
    JournalAmerican Journal of Respiratory and Critical Care Medicine
    Volume183
    Issue number4
    DOIs
    Publication statusPublished - 15 Feb 2011

    Keywords

    • QUALITY-OF-LIFE
    • bronchiectasis
    • CHRONIC BRONCHIAL INFECTION
    • TOBRAMYCIN SOLUTION
    • OBSTRUCTIVE PULMONARY-DISEASE
    • ANTIBIOTIC-THERAPY
    • gentamicin
    • nebulized anibiotics
    • HEALTH-STATUS
    • ADULT BRONCHIECTASIS
    • PSEUDOMONAS-AERUGINOSA
    • LEICESTER COUGH QUESTIONNAIRE
    • GEORGES RESPIRATORY QUESTIONNAIRE

    Cite this

    Murray, M. P., Govan, J. R. W., Doherty, C. J., Simpson, A. J., Wilkinson, T. S., Chalmers, J. D., Greening, A. P., Haslett, C., & Hill, A. T. (2011). A Randomized Controlled Trial of Nebulized Gentamicin in Non-Cystic Fibrosis Bronchiectasis. American Journal of Respiratory and Critical Care Medicine, 183(4), 491-499. https://doi.org/10.1164/rccm.201005-0756OC