Inhaled antibiotics are used for the treatment of airway infection. Most commonly this will be Pseudomonas - either as part of an eradication protocol or long term suppression. Other indications are B. cepacia infection and M. abscessus infection. See relevant sections of the webiste for more details.
All Inhaled antibiotics need to be evaluated with a test dose, with spirometry (or chest ausculation in young children unable to do spirometry) before and after the first dose.
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Drug
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Dose
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Notes
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Amikacin
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Over 6 years: 500mg bd
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Used for long term treatment of M. abscessus.
Made from IV solution. Provided by OUH pharmacy only. Can further dilute injection with 0.9% sodium chloride.
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Amphotericin
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Less than 10 years: 5 mg bd
Over 10 years: 10 mg bd
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For chronic aspergillus. Made from Fungizone iv solution. AmBisome is much more expensive, but may be better tolerated – they both taste
awful, but AmBisome may be less so.
Dilution: 50 mg in 10ml of water. For a 5 mg dose, use 1ml of this solution and dilute further with 2ml of water (minimum volume of 3ml for
nebulisation).
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Aztreonam Lysine (Cayston)
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75 mg tds during alternate months
Licensed for children over 6 years
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3rd Line treatment for Pseudomonas when there is persistent Ps infection, declining lung function and/or frequent exacerbations.
Note that it needs to be given THREE times per day, and the doses should be taken at least 4 hours apart.
Reconstitute only with solvent provided.
It is only available via hospital prescription and home delivery.
Colistin or tobramycin usually given during the intervening month.
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Ceftazidime
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1 gm bd
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For B cepacia.
Made from IV solution. Provided by OUH pharmacy only. Reconstitute 1 gram injection with 3ml water for injection. Tastes awful.
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Colomycin
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Under 2 yrs: 1,000,000 Units bd
Over 2 yrs: 2,000,000 Units bd
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1,000,000 units = 1 megaunit (Mu).
Made from iv solution diluted in 2ml of water plus 2ml 0.9% saline.
It is only available via hospital prescription and home delivery.
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Promixin
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Under 2 yrs: 500,000 units bd
Over 2 yrs: 1,000,000 units bd
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Promixin is exactly the same as colomycin.
Dilute in 50/50 mix of water and saline.
The effective dose is the same as colomycin, but because the Ineb delivers the drug only during inspiration, the dose required is halved.
It is only available via hospital prescription and home delivery.
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Colobreathe turbospin
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1 capsule bd via turbospin powder inhaler
Licensed for children over 6 years only
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Each capsule contains 1,662,500 IU (about 125mg) of colistimethate sodium.
Colobreathe be used if a child will clinically benefit from continued colistin but does not tolerate it in its nebulised form and thus
tobramycin therapy would otherwise be considered.
It is only available via hospital prescription and home delivery.
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Meropenem
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6-12 years: 125mg bd
Over 12 years: 250mg bd
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Used for long term treatment of M. abscessus.
Made from IV solution. Provided by OUH pharmacy only. Reconstitute 500mg vial with 10ml 0.9% sodium chloride.
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Tobramycin
Bramitob or TOBI
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300 mg bd. Can be given tds for 2 weeks to treat exacerbations.
Licensed for children over 6 years of age.
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Used either for a) 2 weeks (tds) as part of treatment of chest exacerbation b) for 4 weeks bd as part of Pseudomonas eradication or c) alternate months (bd) as long term anti-pseudomonal treatment (colistin will often be given in the month off tobramycin).
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Tobramcyin
TOBI Podhaler
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112mg (4 x 28mg capsules) bd via podhaler during
Licensed for children over 6 years only
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It is only available via hospital prescription and home delivery.
Available to any child over 6 years of age on long term tobramycin.
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