Inhaled Imipenem/cilastatin an Alternative Treatment for Lung Infection in Children with CF, Case Reports Show

The inhaled formulation of broad-spectrum antibiotics such as imipenem/cilastatin is a useful alternative to treat chronic lung bacterial infections in children with cystic fibrosis (CF) because it causes fewer side effects, two case reports suggest.

The study, “Use of inhaled imipenem/cilastatin in pediatric patients with cystic fibrosis: A case series,” was published in the Journal of Cystic Fibrosis.

People with CF often have chronic bacterial infections in their airways. Those infections usually are caused by resistant bacteria, which makes them more challenging to manage, especially in children who often develop drug allergies or are less tolerant of the side effects caused by strong antibiotics.

Imipenem/cilastatin is a broad-spectrum antibiotic commonly used to manage resistant bacteria. However, it causes side effects such as toxicity to the liver and gastrointestinal tract when administered intravenously, which can interfere with its prolonged use.

Case reports of adults with and without CF show that an inhaled formulation of imipenem/cilastatin successfully treats bacterial infections — namely Mycobacterium abscessus — and causes fewer side effects because the antibiotic is delivered at the site of infection. However, there were no data on the effect of this formulation in children.

Now, researchers at the University of North Carolina at Chapel Hill reported the cases of two children with CF and chronic lung infections who showed positive results after receiving inhaled imipenem/cilastatin.

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The first patient was a 16-year-old girl who first had chronic lung infection with M. abscessus five years before starting inhaled imipenem/cilastatin. She had received different antibiotics, including intravenous imipenem/cilastatin, but had to stop them because of adverse side effects and reduced effectiveness. The infection caused a decline in her lung function, and difficulty in maintaining weight.

The patient tolerated the inhaled imipenem/cilastatin formulation, and maintained the treatment for approximately a year-and-a-half without significant side effects, only requiring short periods of intravenous antibiotics to further control the infection. Her lung capacity remained stable, with a tendency to increase during the treatment.

The second patient was a 13-year-old boy who had had chronic lung bacterial infection with M. abscessus for five years. Intravenous antibiotics failed at improving lung function, and caused adverse side effects. Doctors later treated him with inhaled imipenem/cilastatin.

The patient tolerated the therapy without complications for six months; during that time, his lung function remained stable. He reported increasing his exercise capacity and coughing less since taking the treatment.

“Both patients have tolerated several months of inhaled IMI/CIL [imipenem/ cilastatin] without reported side effects, and with sustained stable lung function. This has allowed for longer IV [intravenous] antibiotic-free intervals, reduced overall exposure to systemic side effects experienced with previous therapies, and presumably increased quality of life,” the researchers wrote.

Based on the results, the team suggested that “in pediatric CF patients with chronic [Mycobacterium abscessus] pulmonary infections, inhaled IMI/CIL may provide another treatment alternative.”