IV antibiotics no more effective than oral for eradicating infection in cystic fibrosis patients, study suggests

In the TORPEDO-CF trial, 44% of patients assigned to intravenous therapy achieved infection eradication at three months and remained free of infection at 15 months, compared with 52% of those assigned to oral therapy.

Pseudomonas aeruginosa

Intravenous (IV) antibiotics are not superior to oral antibiotics for eradicating Pseudomonas aeruginosa (P. aeruginosa) in cystic fibrosis patients, according to a randomised controlled trial in Lancet Respiratory Medicine (8 October 2020)[1]
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Researchers from the TORPEDO-CF study group compared 14 days of IV ceftazidime and tobramycin with 12 weeks of oral ciprofloxacin treatment among 286 patients with a P. aeruginosa infection from 72 cystic fibrosis centres; of which 70 were in the UK.

Patients assigned to IV therapy were less likely to achieve the primary outcome of infection eradication at 3 months and remaining free of infection at 15 months, although the difference between the groups was not found to be statistically significant.

Of 125 participants in the IV group, 55 (44%) achieved the primary outcome, compared with 68 (52%) of 130 participants in the oral group (relative risk 0.84, 95% confidence interval 0.65–1.09; P=0.18).

An economic analysis showed a cost saving of £5,939 per patient with the use of oral versus IV treatment, despite more patients assigned to the oral treatment group being admitted to hospital during follow-up.

“If the findings of this trial are implemented in routine clinical practice, most patients will receive oral eradication treatment as an outpatient and many hospital admissions will be avoided, which in turn will reduce both treatment burden and health-care costs,” the researchers concluded.

References

[1] Langton Hewer S, Smyth A, Brown M et al. Intravenous versus oral antibiotics for eradication of Pseudomonas aeruginosa in cystic fibrosis (TORPEDO-CF): a randomised controlled trial. Lancet Respir Med 2020;8:975–86. doi: 10.1016/S2213-2600(20)30331-3 

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Citation
The Pharmaceutical Journal, PJ December 2020, Vol 305, No 7944;305(7944):DOI:10.1211/PJ.2020.20208564