Inhaled antimicrobial prescribing for Pseudomonas aeruginosa infections in Europe.

BACKGROUND

Prescribers have an increasing range of inhaled antimicrobial formulations to choose from when prescribing both eradication and chronic suppression regimens in cystic fibrosis (CF). This study aimed to investigate the decision-making process behind prescribing of inhaled antimicrobials for Pseudomonas aeruginosa infections.

METHODS

A questionnaire was developed using Microsoft Forms and then forwarded to 57 Principal Investigators (PIs), at each of the CF centres within the European Cystic Fibrosis Society-Clinical Trials Network (ECFS-CTN). Data collection occurred between November 2021 and February 2022.

RESULTS

The response rate was 90 % (n = 51/57 PIs), with at least 50 % of CF centers in each of the 17 countries represented in the ECFS-CTN. Physicians used a median of eight factors in their decision-making process with delivery formulations (92.2 %), adherence history (84.3 %), and antibiotic side-effect profile (76.5 %) often selected. Nebulised tobramycin or colistin were frequently selected as the inhaled antimicrobial in first-line eradication (n = 45, 88.2 %) and chronic suppression regimens (n = 42, 82.4 %). Combination regimens were more often chosen in eradication (first-line: n = 35, 68.6 %, second-line: n = 34, 66.7 %) and later chronic suppression regimens (third-line: n = 27, 52.9 %) than monotherapy. For pwCF also prescribed CFTR modulator therapies, most PIs did not alter inhaled antimicrobial regimens (n = 40, 78.4 %), with few pwCF (n = 18, 35.3 %) or PIs (n = 10, 19.6 %) deciding to stop inhaled antimicrobials.

CONCLUSIONS

The inhaled antimicrobial prescribing decision-making process is multifactorial. Nebulised tobramycin or colistin are often used in initial eradication and chronic suppression regimens. To date, CFTR modulator therapy has had a limited impact on the prescribing of inhaled antimicrobial regimens.

Informations de copyright

Copyright © 2023. Published by Elsevier B.V.

Déclaration de conflit d'intérêts

Declaration of competing interest Callum Sloan - PhD project funded by Chiesi and received an ECFS Travel Grant. Laura Sherrard - received PhD fellowship support to institution from Chiesi. Gisli Einarsson and Lieven Dupont - no interests to declare. Silke van Koningsbruggen-Rietschel - received consulting fees from German center for Infection Research, Antabio, and Boehringer. Nicholas Simmonds - received honoraria from Vertex, Chiesi, and Gilead, on the consulting fees for Vertex, Chiesi, Gilead, and Menarini, received support for attending conference from Vertex and has roles on the ECFS-Clinical Trials Network Executive Committee, ECFS Diagnostic Network Working Group as Co-coordinator, and the UK CF Registry Research Committee. Damian Downey - received PhD fellowship support to institution from Chiesi, grants from Chiesi and Gilead, honoraria from Vertex, Gilead, Chiesi, and Insmed, and is Director of the ECFS-Clinical Trials Network. Preliminary data from the study was presented as an abstract and poster presentation entitled ‘P150 Antimicrobial prescribing in people with cystic fibrosis: exploring inhaled antimicrobial use for Pseudomonas aeruginosa infections across the ECFS-CTN” Journal of Cystic Fibrosis 2022: 21: S107 at the 45th European Cystic Fibrosis Society Conference in Rotterdam (8th-11th June 2022).