Spotlight on inhaled ciprofloxacin and its potential in the treatment of non-cystic fibrosis bronchiectasis
Stamatia Chorepsima,1,2 Konstantinos S Kechagias,1 Georgios Kalimeris,1,2 Nikolaos A Triarides,1,2 Matthew E Falagas1–3 1Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; 2Department of Medicine, Henry Dunant Hospital Center, Athens, Greece; 3Department of Medicine, Tufts Univ...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2018-11-01
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| Series: | Drug Design, Development and Therapy |
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| Online Access: | https://www.dovepress.com/spotlight-on-inhaled-ciprofloxacin-and-its-potential-in-the-treatment--peer-reviewed-article-DDDT |
| _version_ | 1818328070053953536 |
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| author | Chorepsima S Kechagias KS Kalimeris G Triarides NA Falagas ME |
| author_facet | Chorepsima S Kechagias KS Kalimeris G Triarides NA Falagas ME |
| author_sort | Chorepsima S |
| collection | DOAJ |
| description | Stamatia Chorepsima,1,2 Konstantinos S Kechagias,1 Georgios Kalimeris,1,2 Nikolaos A Triarides,1,2 Matthew E Falagas1–3 1Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; 2Department of Medicine, Henry Dunant Hospital Center, Athens, Greece; 3Department of Medicine, Tufts University School of Medicine, Boston, MA, USA Abstract: Non-cystic fibrosis bronchiectasis (NCFB) is a severe chronic illness characterized by irreversible dilation of airways and thickening of bronchial walls, chronic inflammation, repeated infections, and progressive obstruction of the airways. In contrast to cystic fibrosis bronchiectasis (CFB), which is a well-defined genetic disorder, NCFB is a heterogeneous disease caused by many different medical entities. Inhaled antibiotics are effective for patients with CFB, but their efficacy in NCFB has not been proven. The main pathogens involved in the colonization of patients with bronchiectasis are Haemophilus influenza, Moraxella catarrhalis, Staphylococcus aureus, and Pseudomonas aeruginosa. The latter is associated with increased morbidity and mortality. In addition, in NCFB, P. aeruginosa strains are frequently more resistant than those in CFB. At present, there are no approved inhaled antibiotic therapies for NCFB patients. Inhaled ciprofloxacin has been under investigation in the last few years. In two phase II randomized, double-blind, placebo-controlled trials, the use of inhaled ciprofloxacin was significantly associated with reduction in sputum bacterial density and greater eradication rates. In four phase III randomized, double-blind, placebo-controlled trials, the results regarding the time of the first exacerbation and the rate of exacerbations were inconsistent. Specifically, ORBIT-4 and RESPIRE-1 trials showed clinical benefit (prolongation of the time of the first exacerbation and reduced rate of exacerbations in the treatment group compared to the placebo group), whereas the ORBIT-3 and RESPIRE-2 failed to achieve their primary endpoints. The RESPIRE-1 was the first trial that examined the 14-days on/off course separate from the standard 28-days on/off regimen, which is based on CFB protocol treatments. The current data on the efficacy of inhaled ciprofloxacin are encouraging, but further evaluation is needed to determine the appropriate target group and the ideal duration of treatment. Keywords: aerosolized antibiotics, ciprofloxacin, bronchiectasis, fluoroquinolone |
| first_indexed | 2024-12-13T12:26:19Z |
| format | Article |
| id | doaj.art-5f9f93e152a142308fc4cd2ab05ae2be |
| institution | Directory Open Access Journal |
| issn | 1177-8881 |
| language | English |
| last_indexed | 2024-12-13T12:26:19Z |
| publishDate | 2018-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Drug Design, Development and Therapy |
| spelling | doaj.art-5f9f93e152a142308fc4cd2ab05ae2be2022-12-21T23:46:17ZengDove Medical PressDrug Design, Development and Therapy1177-88812018-11-01Volume 124059406642650Spotlight on inhaled ciprofloxacin and its potential in the treatment of non-cystic fibrosis bronchiectasisChorepsima SKechagias KSKalimeris GTriarides NAFalagas MEStamatia Chorepsima,1,2 Konstantinos S Kechagias,1 Georgios Kalimeris,1,2 Nikolaos A Triarides,1,2 Matthew E Falagas1–3 1Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece; 2Department of Medicine, Henry Dunant Hospital Center, Athens, Greece; 3Department of Medicine, Tufts University School of Medicine, Boston, MA, USA Abstract: Non-cystic fibrosis bronchiectasis (NCFB) is a severe chronic illness characterized by irreversible dilation of airways and thickening of bronchial walls, chronic inflammation, repeated infections, and progressive obstruction of the airways. In contrast to cystic fibrosis bronchiectasis (CFB), which is a well-defined genetic disorder, NCFB is a heterogeneous disease caused by many different medical entities. Inhaled antibiotics are effective for patients with CFB, but their efficacy in NCFB has not been proven. The main pathogens involved in the colonization of patients with bronchiectasis are Haemophilus influenza, Moraxella catarrhalis, Staphylococcus aureus, and Pseudomonas aeruginosa. The latter is associated with increased morbidity and mortality. In addition, in NCFB, P. aeruginosa strains are frequently more resistant than those in CFB. At present, there are no approved inhaled antibiotic therapies for NCFB patients. Inhaled ciprofloxacin has been under investigation in the last few years. In two phase II randomized, double-blind, placebo-controlled trials, the use of inhaled ciprofloxacin was significantly associated with reduction in sputum bacterial density and greater eradication rates. In four phase III randomized, double-blind, placebo-controlled trials, the results regarding the time of the first exacerbation and the rate of exacerbations were inconsistent. Specifically, ORBIT-4 and RESPIRE-1 trials showed clinical benefit (prolongation of the time of the first exacerbation and reduced rate of exacerbations in the treatment group compared to the placebo group), whereas the ORBIT-3 and RESPIRE-2 failed to achieve their primary endpoints. The RESPIRE-1 was the first trial that examined the 14-days on/off course separate from the standard 28-days on/off regimen, which is based on CFB protocol treatments. The current data on the efficacy of inhaled ciprofloxacin are encouraging, but further evaluation is needed to determine the appropriate target group and the ideal duration of treatment. Keywords: aerosolized antibiotics, ciprofloxacin, bronchiectasis, fluoroquinolonehttps://www.dovepress.com/spotlight-on-inhaled-ciprofloxacin-and-its-potential-in-the-treatment--peer-reviewed-article-DDDTaerosolized antibioticsciprofloxacinbronchiectasisfluoroquinolone |
| spellingShingle | Chorepsima S Kechagias KS Kalimeris G Triarides NA Falagas ME Spotlight on inhaled ciprofloxacin and its potential in the treatment of non-cystic fibrosis bronchiectasis Drug Design, Development and Therapy aerosolized antibiotics ciprofloxacin bronchiectasis fluoroquinolone |
| title | Spotlight on inhaled ciprofloxacin and its potential in the treatment of non-cystic fibrosis bronchiectasis |
| title_full | Spotlight on inhaled ciprofloxacin and its potential in the treatment of non-cystic fibrosis bronchiectasis |
| title_fullStr | Spotlight on inhaled ciprofloxacin and its potential in the treatment of non-cystic fibrosis bronchiectasis |
| title_full_unstemmed | Spotlight on inhaled ciprofloxacin and its potential in the treatment of non-cystic fibrosis bronchiectasis |
| title_short | Spotlight on inhaled ciprofloxacin and its potential in the treatment of non-cystic fibrosis bronchiectasis |
| title_sort | spotlight on inhaled ciprofloxacin and its potential in the treatment of non cystic fibrosis bronchiectasis |
| topic | aerosolized antibiotics ciprofloxacin bronchiectasis fluoroquinolone |
| url | https://www.dovepress.com/spotlight-on-inhaled-ciprofloxacin-and-its-potential-in-the-treatment--peer-reviewed-article-DDDT |
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