Tolerance of nebulised gentamicin in adult bronchiectasis - A single centre study

Background: British Thoracic Society non CF bronchiectasis (nCFBr) guidelines suggest that long-term nebulised antibiotics should be considered in patients with more than 3 exacerbations per year. Nebulised gentamicin reduces bacterial load and exacerbations in nCFBr. Adverse effects can occur with aerosolized delivery of antimicrobials and so limit their use. We studied the tolerability of nebulised gentamicin in a real world population Methods: We measured spirometry in nCFBr patients challenged with 80mg of nebulised gentamicin, at baseline, 1min, 5min, and 10min post nebulised gentamicin. Long term tolerability and benefits were assessed Results: Forty-two patients (19male:23female) were enrolled Feb 2010-Dec 2011. Mean age was 60yrs (range 17-77). Colonisation with P.aeruginosa , H.influenzae and S.aureus was seen in 17(40%), 11(26%) and 4(9%) patients respectively. Mean baseline FEV1 was 1.48L/min (56% pred), range 0.3-3.75L/min (16-108% pred). Mean FEV1 was preserved at 1min (1.45L/min), 5min (1.52L/min) and 10min (1.53L/min) post nebulised gentamicin. There was no difference between pre-dose and 10min post-dose FEV1 (p>0.05). One patient was unable to tolerate the nebulised challenge due to fall in FEV1 and symptoms. Long-term, 8 patients (19%) were unable to tolerate nebulised gentamicin due to side effects. It was stopped in 5 patients (12%) as they did not report benefits Conclusions: These data show nebulised gentamicin is well tolerated in acute challenges even in patients with severe airflow obstruction but long-term adherence declines. We aim to present microbiological data. The utility of acute challenge tests remain unclear in predicting longer term tolerability.