Inhaled or nebulised ciprofloxacin for the maintenance treatment of bronchiectasis.

INTRODUCTION: Inhaled or nebulised antibiotics are a major topic of ongoing research interest in reducing exacerbations in bronchiectasis. There are no licenced inhaled or nebulised antibiotics currently in bronchiectasis. Areas covered: Inhaled or nebulised ciprofloxacin as a long-term treatment in bronchiectasis. Expert opinion: Results from the Phase III ongoing trials on inhaled or nebulised ciprofloxacin will be key for the outcome of the drugs but additionally, cost-effectiveness and longer-term studies will be necessary to determine the viability of the drug. Head to head studies are needed to decide on the optimum inhaled or nebulised antibiotic and their place with or without long term macrolide therapy. It is also important to determine what treatment is viable for acute exacerbations due to P. aeruginosa. Ciprofloxacin is the only currently available oral agent for exacerbations due to P. aeruginosa. The concern is that using inhaled or nebulised ciprofloxacin will prevent the use and efficacy of its oral equivalent, by developing resistance.