Cystic fibrosis (CF) is a genetic condition that affects mucus glands, causing sticky mucus in the lungs and digestive system. People with CF are prone to lung infection with a bacteria called Pseudomonas aeruginosa, which can lead to serious long term complications and death. It is possible to get rid of (eradicate) Pseudomonas aeruginosa if antibiotics are started promptly and taken for several months.
The TORPEDO-CF trial was designed to find out if intravenous ceftazidime and tobramycin were better at eradicating Pseudomonas aeruginosa than oral ciprofloxacin.
A total of 286 children, young people and adults with CF joined the study from 70 UK and 2 Italian centres. Approximately half received treatment with intravenous antibiotics and half with oral. All received inhaled colistin for three months and were followed up for a minimum of 15 months.
We studied whether the either treatment eradicated Pseudomonas aeruginosa and if re-infection happened during follow-up. We also collected data on lung function, other chest infections, hospital admissions, and examined whether one treatment was more cost-effective than the other.
15 adults in total joined TORPEDO-CF so the study population may not totally match the wider CF population, however in TORPEDO-CF we found that intravenous antibiotics did not achieve persistent eradication of Pseudomonas aeruginosa in a greater proportion of CF patients. We also found that oral antibiotics were more cost-effective than intravenous. The intravenous antibiotics group had fewer hospital admissions during follow-up, but as they were usually admitted for their initial treatment this was not considered an advantage.
TORPEDO-CF results do not support the use of intravenous antibiotics to eradicate Pseudomonas aeruginosa in CF and, when the findings of this trial are applied in routine clinical practice in the NHS, patients will most likely receive oral treatment as an outpatient, avoiding the need for hospital admission.
- Tudur Smith, C., et al. (2014). "Risk-proportionate clinical trial monitoring: an example approach from a non-commercial trials unit." Trials 15(1): 127.
- Intravenous versus oral antibiotics for eradication of Pseudomonas aeruginosa in cystic fibrosis (TORPEDO-CF): a randomised controlled trial