Oral antibiotics are as effective as IV antibiotics for the eradication of PseudomonasOral antibiot

The results of the long-running 'Torpedo' clinical trial investigating two different approaches to the eradication of a serious cystic fibrosis (CF) lung infection were published this week. They show that oral antibiotics are as effective as intravenous antibiotics for removing the first infection of Pseudomonas aeruginosa.

The bacteria Pseudomonas aeruginosa (P. aeruginosa) causes serious lung infections in people with cystic fibrosis. It is important to prescribe antibiotics as early as possible, to remove (‘eradicate’) the infection and prevent it from becoming established in the lungs. Once it becomes established, antibiotics are used to manage the infection and minimise the amount of lung damage that it causes. There are two approaches for that first course of antibiotics: people with CF will either by given a course of oral antibiotics, which they can take at home, or they’ll be admitted to hospital and given a course of intravenous (IV) antibiotics. The first course of antibiotics is known as an ‘eradication therapy’ as its aim is to remove the infection from the lungs completely. Later treatments aim to suppress the infection or manage any ‘flare-ups’ of a sudden worsening of lung symptoms.

The Torpedo study

Bristol-based CF clinician Dr Simon Langton-Hewer wanted to know whether people with CF receiving the IV course of antibiotics did better than those on the oral course of antibiotics. A review of past studies didn’t answer his question, so he ran the ‘Torpedo’ clinical trial to find out.

Over a 10-year period, he and CF clinicians across the UK recruited 286 people with CF with their first P. aeruginosa infection into the trial. The majority of participants were under 18 years old. Half received oral antibiotics and half received the IV antibiotics. Each participant was followed for 12 months after their trial antibiotics were completed. The study measured whether IV treatment was better than oral treatment by counting the number of people who were clear of infection after treatment and also didn’t get another P. aeruginosa infection for 12 months after treatment ended.

Results of the Torpedo study

The results published this week in the journal Lancet Respiratory Medicine show that there wasn’t a real ‘statistically significant’ difference between those receiving the IV course of antibiotics and those taking tablets. They found that 44% of people receiving the IV treatment and 55% of those receiving the oral treatment cleared the infection and were infection-free for 12 months after the first treatment.

“I’m very excited to be able to share the results of this very important study which has implications for adults and children with CF who have a new infection of Pseudomonas aeruginosa” said Dr Langton-Hewer.

“Our study found that traditional oral antibiotics are just as effective as intravenous antibiotics, which means that CF patients who have a new Pseudomonas aeruginosa can be treated at home and saved the inconvenience of having to be admitted to hospital for treatment.

“The results of the study provide evidence to guide practice in CF centres and will help to reduce unnecessary hospital admissions.”

Dr Keith Brownlee, Director of Policy, Programmes and Support at the Cystic Fibrosis Trust said: “This is great news for people with cystic fibrosis. These findings may reduce the time spent in hospital, where they and their families are forced to take time off work and school. This will ultimately improve quality of life for many people with CF. We continue to invest in research to understand and more effectively treat lung infections in cystic fibrosis. Earlier detection of infection may improve the effectiveness of eradication treatments.”

You can read the research paper in full on the Lancet Respiratory Medicine website.