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Evidence summaries

Once-Daily Dosing of Aminoglycosides for Cystic Fibrosis

Once and three times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 4 studies with a total of 328 subjects assessing the effectiveness and safety of once-daily versus multiple-daily dosing of intravenous aminoglycoside antibiotics for the management of pulmonary exacerbations in cystic fibrosis. All studies compared once-daily dosing with thrice-daily dosing. There was no significant difference between treatment groups in forced expiratory volume at one second (MD 0.33, 95% CI -2.81 to 3.48); forced vital capacity (MD 0.29, 95% CI -6.58 to 7.16); % weight for height (MD -0.82, 95% CI -3.77 to 2.13); body mass index (MD 0.00, 95% CI -0.42 to 0.42); or in the incidence of ototoxicity (RR 0.56, 95% CI 0.04 to 7.96). The percentage change in creatinine significantly favoured once-daily treatment in children (MD -8.20, 95% CI -15.32 to -1.08), but showed no difference in adults (MD 3.25, 95% CI -1.82 to 8.33); in adults the effect was in favour of three-times daily treatment, but was not significant.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

References

  • Smyth AR, Bhatt J, Nevitt SJ. Once-daily versus multiple-daily dosing with intravenous aminoglycosides for cystic fibrosis. Cochrane Database Syst Rev 2017;(3):CD002009. [PubMed].

Primary/Secondary Keywords