Antibiotics

The buildup of thick, sticky mucus in the lungs makes people with cystic fibrosis more likely to develop bacterial infections that can last for short periods of time (known as acute infections or exacerbations) or for many years.

The good news is that many of these infections can be treated. To keep them in check, antibiotics are taken by people with cystic fibrosis as part of regular daily treatment. For lung exacerbations, people with CF may receive intravenous (IV) antibiotics — that is, directly into the veins — in addition to the inhaled or oral antibiotics.

See how inhaled antibiotics work to help control bacteria in your lungs.

Inhaled antibiotics should be taken last, after bronchodilators (if you take them), mucus thinners, and airway clearance techniques, so your lungs will be as clear of mucus as possible. This allows the antibiotics to reach deep into your lungs to treat the bacteria that cause infection.

The tables below list bacteria common among people with CF, the antibiotics that are commonly prescribed to treat them, and how they are taken.

Staphylococcus aureus (Staph)

Pseudomonas (P. aeruginosa)

Learn more about P. aeruginosa.

Methicillin-Resistant Staphylococcus aureus (MRSA)

Learn more about MRSA.

Nontuberculous mycobacteria (NTM)

Learn more about NTM.

Mycobacterium abscessus (M. abscessus)

Intensive Phase

Consolidation Phase

Mycobacterium avium complex (MAC)

Burkholderia cepacia (B. cepacia)

Learn more about B. cepacia.

Stenotrophomonas maltophilia

Haemophilus influenzae

Achromobacter xylosoxidans

CF and Antibiotic Resistance

It is particularly important to take antibiotics exactly as they've been prescribed by your doctor, even if you no longer feel the symptoms of an infection. Not doing so can allow the remaining bacteria in your system to become resistant to the antibiotic, which will make it more difficult to treat.

Antibiotic-resistant infections are a real concern among people with CF and over time, can lead to fewer treatment options. Your CF care team will watch for signs of resistance and help you understand how to prevent or decrease the risk of developing infections from resistant bacteria.

Talk to your care team if you have questions about how to take the antibiotic, including the sequence for taking the drug in relation to your other treatments, what you should expect and do if you experience side effects, and what to do if you miss a dose or cannot complete the full course.

Alcohol interferes with the effectiveness of many antibiotics. It is a good rule to avoid consuming alcohol while taking antibiotics. Antibiotics also can decrease the effectiveness of oral contraceptives in women.

What Should I Expect After Taking Them?

Antibiotics typically begin working 48 to 72 hours after you begin taking them. It may take a day or so before you start to feel better. As the antibiotics work to break up the mucus, coughing may increase, which is why some people feel worse before they feel better.

You may experience side effects when you take any medication, including antibiotics. When discussing any new medications or changes in dosages for medications you are already taking, be sure to ask your care team about:

• Any potential side effects
• Which side effects might be more serious than others
• How long they might last
• When to talk to your care team if side effects don't go away or if they interfere with your quality of life

Let your care team know if you feel any side effect that bothers you or makes it hard for you to continue taking this medication as prescribed. Your care team can work with you to help you manage side effects or to adjust your treatment plan.

”The shock was something I could not describe. This was the first time I needed to make a choice — my lungs or hearing. Along with the support of my care team, we decided that since the hearing loss was mild, my lungs were my choice. I stayed on amikacin and got daily infusions. By November, my hearing loss went from mild to severe, and I started to notice the effects of this loss in my day-to-day life.” — Samantha Marino, adult with CF, from the CF Community Blog.

You can learn more about antibiotics at DailyMed, which is a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects. You can learn more about specific antibiotics by searching for the medication from the main DailyMed page.

Where Are These Medications Available?

For IV antibiotics given in the hospital, clinic, or hospital, staff work with the appropriate individuals to provide the therapy. For IV antibiotics that will be administered at home, clinic, or hospital, staff work with home care agencies to arrange delivery and therapy. Oral antibiotics are typically available at retail pharmacies and mail-order pharmacies. Inhaled antibiotics are available through specialty pharmacies that are contracted with specific insurance plans. Medications from specialty pharmacies often need to be handled and stored specially and delivered quickly.

Insurance plan coverage for some antibiotics can vary. For antibiotics that are specifically indicated for CF treatment, most insurance providers should provide coverage. For antibiotics that are not specifically indicated for CF treatment, insurance coverage may be more difficult to arrange. For example, although the antibiotic colistimethate (Colistin^®) is often prescribed as an inhaled treatment for P. aeruginosa, it is considered an injectable antibiotic. Because it is not specifically indicated to be used in that way, coverage may be declined by insurers. Check with your insurance provider to ensure that the antibiotic is covered and confirm what your out-of-pocket expenses may be. 

You can also contact the Cystic Fibrosis Foundation Compass, a free, personalized service that can help you with insurance, financial, legal, and other issues. Dedicated Compass case managers can assist in coordinating benefits or providing information about benefits offered under your plans. Contact Compass at: 

844-COMPASS (844-266-7277) 
Monday - Friday, 9 a.m. - 7 p.m. ET
compass@cff.org

Inhaled antibiotics are used to fight or control bacteria that cause lung infections. Your CF care team will use the results of a sputum culture to see if you need to take an inhaled antibiotic. Inhaled antibiotics go right to where they are needed — deep into the small airways in your lungs.

The following antibiotics are used to improve respiratory symptoms in people with CF who have Pseudomonas aeruginosa. The antibiotics especially made for people to inhale are:

• Aztreonam inhalation solution (Cayston^®)
• Tobramycin inhalation solution (such as TOBI^®, Bethkis^®, Kitabis Pak^®, generic)
• Tobramycin inhalation powder (TOBI^® Podhaler™)
• An inhaled form of amikacin, Arikayce^®, has been approved for the treatment of M. avium complex.

Who Should Take Them?

Typically, patients do only one of these products every other month for 28 days.  However, there are some people who alternate between taking aztreonam and tobramycin. For example, people take aztreonam for 28 days and then switch to tobramycin for another 28 days.

Aztreonam is approved for people ages 7 and older who have P. aeruginosa, but it has been studied in younger children. People taking aztreonam should take one single-dose vial three times per day with a recommended nebulizer.

Tobramycin inhalation solution and tobramycin inhalation powder are approved for people ages 6 and older who have P. aeruginosa, but the inhalation solution has been studied in younger children.

How Do I Take Them? 

Aztreonam and tobramycin inhalation solution are administered with a nebulizer. There are several different types of nebulizer and compressor devices. 

Your CF care team can show you how to use these devices correctly. With most types of nebulizers, the drug is put in a clean nebulizer cup and attached to a small air compressor. The compressor blows air through the nebulizer cup, which creates a mist that you inhale through a mouthpiece.

There are several different types of nebulizers and compressor devices, depending on which medication is being administered. Tobramycin inhalation powder uses a portable handheld device. Certain aerosol medications require you to use specific devices. Use only recommended nebulizers.

To take aztreonam inhalation solution:

• Wash and dry your hands.
• Make sure the nebulizer is on a flat surface.
• Pour only mixed aztreonam inhalation solution into the medication reservoir of the nebulizer. Do not pour aztreonam powder into the medication reservoir. Do not use other medications in the Altera nebulizer handset.
• Align the tabs on the medication cap with the tab slots on the medication reservoir. Turn the medication cap clockwise until it stops. Your Altera nebulizer handset is now ready, and you can begin your treatment.
• To begin your treatment, sit in a relaxed, upright position. Press and hold the on/off button for a few seconds. You will hear one “beep” and the status light will illuminate green. The eFlow technology logo will appear. This is the start screen.
• After a few seconds, aerosol mist will begin to flow into the aerosol chamber of the Altera nebulizer handset.
• Your controller is designed to display the treatment screen if the Altera nebulizer system is assembled correctly and working properly.
• Place the mouthpiece on top of your bottom lip and tongue and close your lips around it. Hold the Altera nebulizer handset level. If held at an angle greater than 45 degrees, the aerosol head will emit two beeps and the status light on the controller will flash two green lights. After approximately 30 seconds, the controller will shut off. If this occurs, hold the Altera nebulizer handset level and press the controller's on/off button to resume the treatment.
• Breathe normally in and out through the mouthpiece. Continue to inhale and exhale comfortably until the treatment is finished.
• When all of the medication has been delivered you will hear the Aerosol Head emit two beeps, the dose complete screen will appear, and the controller will automatically shut off.
• After the controller has shut off automatically at the end of the treatment, open the medication cap to ensure that only a few drops of medication remain in the medication reservoir. If more than a few drops remain, replace the medication cap and resume the treatment until only a few drops remain in the medication reservoir. Once the treatment is complete, disassemble the Altera nebulizer handset for cleaning.

Watch how to clean the Altera nebulizer.

Treatment should take about 2 to 3 minutes to complete and is given three times a day. Doses should be at least four hours apart. When you are finished, wash the nebulizer.

Tobramycin Inhalation Powder 

The inhalation powder form of tobramycin (TOBI^® Podhaler™) is typically taken as four capsules, twice each day.

To take tobramycin inhalation powder:

• Place only one capsule in the inhalation device at a time.
• Press the blue button.
• Place the mouthpiece in your mouth and inhale in one breath.
• Begin inhaling the medication by breathing slowly and deeply.
• Hold your breath for about five seconds.
• Exhale and take a couple of normal breaths away from the inhalation device.
• Inhale again and hold your breath for about five seconds.
• Check to make sure you have used all the medication.
• When you have inhaled all the capsules, clean the mouthpiece with a cloth.

Treatment should take between two and seven minutes to complete.

You should take the medication as close to 12 hours apart as possible and not less than six hours apart.

For complete instructions on how to take tobramycin inhalation powder, visit DailyMed, a service from the U.S. National Library of Medicine that provides FDA label information on marketed drugs.

Oral antibiotics are liquids, tablets, or capsules that you swallow. Oral antibiotics can be used to treat chronic bacterial infections or mild exacerbations.

How Do I Take Them?

Different oral antibiotics can have different effects and requirements. For example, certain antibiotics are taken once each day for several days. Others can be prescribed for longer periods of time. Some need to be taken with food, others on an empty stomach. Your CF care team members will prescribe the antibiotic they think will be most effective for your infection. They will provide instructions on how to take the antibiotic and tell you about possible side effects.

Intravenous (IV) antibiotics are liquid solutions with antibiotics that are delivered directly into your blood through a small tube called an IV catheter. They can be used to treat infections that are caused by bacteria that have not responded to oral antibiotics or infections that have progressed too far to be successfully treated with oral antibiotics.

IV antibiotics are often necessary to treat CF pulmonary exacerbations. People with pulmonary exacerbations who need IV antibiotics are often admitted to the hospital to start treatment so that the antibiotic dosage and potential side effects can be carefully monitored. Sometimes, if they are able to get the extra airway clearance and nutrition at home, they can complete the IV antibiotics at home.

How Do I Take Them?

IV antibiotics are typically administered by medical professionals when you are in the hospital. They can be delivered by placing an IV catheter in your arm. For home use, you may have a health care professional come to your home to teach you how to administer them.

The CF Foundation supports ongoing infection research, including research regarding inflammation.

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Reference to any specific product, process, or service does not necessarily constitute or imply its endorsement, recommendation, or favoring by the Cystic Fibrosis Foundation. The appearance of external hyperlinks does not constitute endorsement by the Cystic Fibrosis Foundation of the linked websites, or information, products, or services contained therein.

Information contained on this site does not cover all possible uses, actions, precautions, side effects, or interactions. This site is not intended as a substitute for treatment advice from a medical professional. Consult your doctor before making any changes to your treatment.

FDA-approved drug information is available at dailymed.nlm.nih.gov/dailymed.