Aminoglycosides are effective against Pseudomonas aeruginosa but with
intravenous administration there are only very low concentrations achieved in sputum; therefore in order to obtain therapeutic levels in patients with endobronchial
infections should be administered high doses with increased likelihood to produce both nephrotoxic and ototoxic effects. Direct
aerosol delivery of
aminoglycosides to the lower respiratory tract has the advantage to achieve high
antibiotic sputum concentrations in the infected area with reduced risk of systemic toxic reactions because of minimal absorption into the circulation. Nowadays, except for patients suffering from
cystic fibrosis and
bronchiectasis, the administration of
antibiotics through
inhalers is not very much in use. The aim of this study was to administer nebulized
tobramycin in chronic
respiratory infections developed during the evolution of
Wegener's Granulomatosis in order to obtain data concerning the safety and efficacy of inhaled
aminoglycosides. The results obtained underlined an improvement in FEV1, FEF75 and PaO2. The aerosolized
tobramycin administered in 300 mg doses three times per day for four weeks, showed itself to be effective and safe, not causing any undesirable clinical or microbiological side-effects. Moreover, a long term treatment has been shown to control the
Pseudomonas aeruginosa infection on the bronchial system in
Wegener's granulomatosis and reduce the frequency of exacerbations in chronic patients.