Background: Bronchiectasis occurred in a 89-year-old man with chronic obstructive pulmonary disease. The inhaled aminoglycoside antibiotic (80mg gentamicin in 2ml normal saline 3 times a day for 5 days) was administered via a tracheostomy tube because of renal insufficiency during hospitalisation.
Objectives: Gentamicin was generally used as intramuscular or intravenous injection. We aimed to confirm the efficacy of inhaled gentamicin based on an evidence approach.
Methods: Setting, patient, intervention, comparison and outcome were established (PICO, Table 1) to form a therapy question. In the Pubmed, Cochrane and other databases, using MeSH terms and Boolean logic combinations (Bronchiectasis AND (Inhaled OR Aerosolized OR Nebulized) Gentamicin) for the literature search. Filters were activated to randomised-controlled trials, published in the last 10 years, in humans. Finally the literature (Am J Respir Crit Care Med. 2011 Feb 15;183(4):491-9.) was selected for appraisal using the Critical Appraisal Skills Programme (CASP) checklist.
Results: Baseline characteristics of the experimental group were similar to the control group (P>0.05). Losses to follow-up were less than 20% in the study. Although the design was a single-masked study, indicators such as the primary microbiological endpoint were not influenced by subjective consciousness. Gentamicin inhalation for bronchiectasis reduced inflammation markers (P<0.05), re-exacerbate rate (P<0.0001), and bacterial density (P< 0.0001) (Tables 2-3). However, no significant differences were found in the pulmonary function test. 21.9% patients reported bronchospasm and received beta-2 agonist treatment. The level of evidence (Oxford Centre for Evidence-based Medicine, OCEBM) was 2 and the grade of recommendation was B.
Conclusions:We found nebulised gentamicin to be a reasonable therapy for patients with renal insufficiency. Our patient's condition was relatively stable after this treatment. Bronchospasm did not occur till after he was discharged. Gentamicin inhalation twice daily was recommended more than three times a day according to the literature and a consideration of drug costs in Taiwan.