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 Inhaled Antibiotics?
Typically, patients do only one of these products every other month for 28 days. But some people alternate between taking aztreonam and tobramycin. For example, people may 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 Pseudomonas, 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 Pseudomonas, but the inhalation solution has been studied in younger children.
How Do I Take Inhaled Antibiotics?
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.
The types of nebulizer or compressor device depends 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 about 30 seconds, the controller will shut off. If this happens, 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.
