Comparing Efficacy of Once vs Thrice Daily Aminoglycosides in Cystic Fibrosis

Once-daily and thrice-daily treatment with aminoglycosides appear to be equally effective for reducing pulmonary exacerbations in cystic fibrosis (CF), a review article in the Cochrane Database of Systematic Reviews suggests.

The systematic review included published and unpublished randomized controlled trials in the CF Specialist Register from the Cochrane CF and Genetic Disorders Group’s editorial base. Only trials that compared once-daily dosing of aminoglycosides with thrice-daily dosing in patients with CF that reported on efficacy (ie, change in pulmonary exacerbations) and/or toxicity outcomes were included. A total of 5 studies comprising 354 participants between the ages of 5 and 50 years were included in the final review. Studies compared once-daily dosing of aminoglycoside antibiotics with thrice-daily dosing.

There were no differences between the once-daily and thrice-daily administration of aminoglycoside antibiotics in terms of forced expiratory volume in 1 second (mean difference [MD], 0.33; 95% CI, -2.81 to 3.48, moderate-quality evidence), forced vital capacity (MD, 0.29; 95% CI, -6.58 to 7.16, low-quality evidence), percentage change in weight/height (MD, -0.82; 95% CI, -3.77 to 2.13, low-quality evidence), body mass index (MD, 0.00; 95% CI, -0.42 to 0.42, low-quality evidence), or incidence of posttreatment ototoxicity (relative risk, 0.56; 95% CI, 0.04-7.96, moderate-quality evidence).

Once-daily dosing of aminoglycoside was potentially associated with improvements in the percentage change in creatinine in children (MD, -8.20; 95% CI, -15.32 to -1.08), based on moderate-quality evidence. No difference in creatinine change was observed in adults (MD, 3.25; 95% CI, -1.82 to 8.33), also based on moderate-quality evidence.

The authors concluded that although once-daily dosing can be as effective as and more convenient than thrice-daily treatment, further studies should be conducted to determine the long-term safety of this treatment schedule.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Bhatt J, Jahnke N, Smyth AR. Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis [published online September 4, 2019]. Cochrane Database Syst Rev. doi:10.1002/14651858.CD002009.pub7