Man with bronchiectasis using nebulised antibiotics

Bronchiectasis, a chronic lung condition characterised by widened and damaged airways, can be a challenging beast to tame. But here’s a ray of hope – nebulised antibiotics. They’ve emerged as a game-changer, especially for those with non-cystic fibrosis (non-CF) bronchiectasis. This article looks into the world of nebulised antibiotics like Colomycin, Gentamicin, Aztreonam, Tobramycin, and Meropenem.

Understanding Nebulised Antibiotics

Definition and Mechanism

What are nebulised antibiotics, you ask? Picture this: a fine mist of medication, directly targeting the lungs. They bypass the digestive system and head straight to the affected area, offering a more direct and often more effective treatment, whilst reducing systemic side-effects.

Benefits over other forms of antibiotics

Why opt for nebulised antibiotics? For starters, they reduce systemic side effects since they’re delivered directly to the lungs. Plus, they pack a punch directly at the infection site, making them a go-to for managing chronic lung infections.

Safety Measures and First Dose Administration

The first dose of nebulised antibiotics is adminsitered in a controlled hospital setting to maximise patient safety and treatment effectiveness. This crucial step involves a comprehensive ‘nebuliser trial,’ which includes detailed lung function tests and vigilant monitoring for any immediate side effects.

A specialist chest physiotherapist often leads this process, employing their expertise to ensure the patient’s suitability for the therapy. This proactive and meticulous approach significantly minimises the risk of adverse reactions, setting a solid foundation for successful and safe treatment.

Colomycin (Colistimethate Sodium)

In the treatment of non-CF bronchiectasis, healthcare professionals most commonly use Colomycin, also known as Colistimethate Sodium, as the preferred nebulised antibiotic. This drug plays a crucial role in the array of antibiotics designated for this condition.

What is Colomycin?

Colomycin belongs to the polymyxin group of antibiotics, known for their effectiveness against certain Gram-negative bacteria, particularly Pseudomonas aeruginosa. It operates by disrupting the bacterial cell membrane, effectively killing the bacteria. This mechanism makes it a valuable option, especially in cases where other antibiotics may not be as effective.

Administration via Nebuliser

Colomycin can be delivered via a standard nebuliser but for more rapid delivery it can be adminsitered via a e-flow or i-neb device. When prescriped as Promixin, the i-neb system must be used.

Dosage in Non-CF Bronchiectasis

Dosage of Colomycin for non-CF bronchiectasis patients is carefully calibrated. Generally, adults may receive 1 to 2 million international units (IU) twice daily via nebulisation. However, this can vary based on individual factors such as the patient’s specific health condition and response to the treatment. When prescribed as Promixin, the typical dosage for adults with non-CF bronchiectasis is 1 million units (MU) of Colomycin, administered twice daily. This dosage can be adjusted based on individual patient needs, including the severity of the lung infection and the patient’s overall response to the treatment. The goal is to find an effective dose that minimises potential side effects, whilst still maintaining efficacy.

Adverse Effects

Common side effects of Colomycin include cough, breathlessness, and sometimes throat irritation. Rarely, it can cause more severe reactions like bronchospasm. To manage these effects, it’s important to use the correct type of nebuliser and to stay well-hydrated, as this can help keep the airways clear and reduce irritation. Rinsing the mouth after nebulisation can prevent throat discomfort, and practicing deep breathing may also be beneficial.


What is Tobramycin?

Tobramycin, part of the aminoglycoside antibiotic family, is effective against a variety of Gram-negative bacteria, notably Pseudomonas aeruginosa, which frequently infects individuals with non-CF bronchiectasis. It functions by halting bacterial protein synthesis, crucial for bacterial growth, thereby playing a pivotal role in treating persistent lung infections associated with this condition.

Administration via Nebuliser

For non-CF bronchiectasis, Tobramycin is typically administered via a nebuliser, transforming the medication into an inhalable mist. This direct delivery to the lungs enhances efficacy while reducing systemic absorption and side effects.

Specific Nebulisers: Tobi and Tobi Podhaler

In the realm of nebulised Tobramycin, two notable delivery systems are the Tobi nebuliser and the Tobi Podhaler. The Tobi system utilises traditional nebulisation to deliver Tobramycin in liquid form. Conversely, the Tobi Podhaler, a more recent innovation, is a dry powder inhaler that offers a quicker and more convenient method of administration. The choice between these systems can depend on patient preference, lifestyle, and specific medical requirements.

Dosage Considerations

In adult patients with non-CF bronchiectasis, the standard dosage for nebulised Tobramycin via the Tobi system is typically 300 mg, administered twice daily. For the Tobi Podhaler, the standard dose is 1125 mg (28 mg capsules x 4) of Tobramycin, inhaled twice daily. It’s important to note that the exact dosage and treatment duration might vary, tailored to the individual’s response and the severity of the infection.

Adverse Effects

Common side effects of nebulised Tobramycin include cough, alterations in voice, and sometimes breathlessness. Given its aminoglycoside class, there’s a potential, albeit lower, risk of ototoxic effects (impact on hearing and balance). To minimise these effects, adherence to the prescribed dosage and administration guidelines is essential.


Gentamicin serves as the second most commonly utilised nebulised antibiotic, specifically targeting lung infections.

What is Gentamicin?

Gentamicin is an aminoglycoside antibiotic, known for its efficacy against a broad range of bacteria, particularly Gram-negative organisms like Pseudomonas aeruginosa, commonly implicated in non-CF bronchiectasis infections. It operates by inhibiting bacterial protein synthesis, crucial for their survival and proliferation. This mode of action makes Gentamicin a valuable choice in the fight against persistent and recurrent lung infections in bronchiectasis.

Administration via Nebuliser

Gentamicin is commonly administered through a nebuliser in the treatment of non-CF bronchiectasis, . This method transforms the antibiotic into an aerosol, allowing for direct inhalation into the lungs. This targeted delivery means that higher concentrations of the medication can reach the site of infection, enhancing its effectiveness while simultaneously reducing the likelihood of systemic side effects that are more common with oral or intravenous administration.

Dosage Considerations

The standard dosage for nebulised Gentamicin in adults with non-CF bronchiectasis typically ranges from 80 mg to 160 mg, administered once or twice daily. However, this can vary depending on individual factors such as the severity of the lung infection, the patient’s overall health, and their response to the treatment. The dosing regimen is carefully determined to ensure efficacy while minimising the risk of side effects.

Adverse Effects

Like other aminoglycosides, common side effects of nebulised Gentamicin can include cough or throat irritation. Although less common, there is also a potential risk for ototoxic effects (affecting hearing and balance) and, rarely, renal impairment. To manage these side effects, patients are advised to adhere strictly to the prescribed dosage and follow the nebulisation instructions accurately.


Aztreonam, as a nebulised antibiotic, plays a significant role in treating non-CF bronchiectasis. It’s important to distinguish between the dosages for nebulised Aztreonam and the specific inhaled Aztreonam device to ensure effective and safe treatment.

What is Aztreonam?

Aztreonam is a monobactam antibiotic, particularly effective against Gram-negative bacteria such as Pseudomonas aeruginosa, a common pathogen in non-CF bronchiectasis. It operates by disrupting bacterial cell wall synthesis, thereby controlling bacterial growth in the lungs.

Administration via Nebuliser and Inhaled Device

For patients with non-CF bronchiectasis, healthcare professionals can administer Aztreonam in two forms: as a nebulised solution or through a specialised inhaled device. These methods aim to deliver the medication directly to the lungs, maximising its effectiveness in treating lung infections and minimising systemic exposure.

Dosage of Nebulised Aztreonam

The standard dosage for nebulised Aztreonam typically involves 75 mg of the medication administered three times a day. This dosage provides an effective concentration of the antibiotic in the lungs, helping to manage and reduce the bacterial load.

Dosage for Inhaled Aztreonam Device

For the inhaled Aztreonam device, the dosage usually is the same, 75 mg per dose, delivered through a specialised inhalation system. This system is designed to optimise the delivery of the drug to the airways, ensuring that the medication is as effective as possible.

Adverse Effects

Common side effects of both nebulised and inhaled Aztreonam include cough, throat irritation, and sometimes wheezing. These effects are generally mild and manageable. Patients are advised to adhere strictly to the prescribed dosage and to follow the specific instructions for the nebulisation or inhalation process.


Meropenem, in its nebulised form, is an important part of the therapeutic arsenal for treating non-CF bronchiectasis. Understanding its role, appropriate dosing, and how to manage its side effects is crucial for effective treatment.

What is Meropenem?

Meropenem is a broad-spectrum carbapenem antibiotic, highly effective against a wide range of bacteria, including several Gram-positive and Gram-negative organisms. It’s particularly valuable in treating lung infections in non-CF bronchiectasis because of its efficacy against bacteria that are often resistant to other antibiotics. Meropenem works by inhibiting cell wall synthesis in bacteria, leading to cell death and thereby controlling the infection.

Dosage Considerations

In adults with non-CF bronchiectasis, the typical dosage for nebulised Meropenem is 250 to 500 mg gram, administered twice daily. This dosing can vary based on the severity of the infection, the patient’s overall health, and their response to the treatment. It’s important that the dosage is determined and monitored by your respiratory infection specialist to ensure efficacy and minimise the risk of adverse effects.

Adverse Effects

Common side effects of nebulised Meropenem include local irritation, such as cough or throat discomfort. Less commonly, patients might experience systemic side effects like gastrointestinal upset or skin rash. To manage these side effects, patients are advised to follow the nebulisation instructions carefully and report any persistent or bothersome side effects to their healthcare provider.

Managing Adverse Effects of Nebulised Antibiotics in Non-CF Bronchiectasis

When it comes to the use of nebulised antibiotics like Colomycin, Gentamicin, Aztreonam, Tobramycin, and Meropenem in treating non-CF bronchiectasis, understanding how to effectively manage potential adverse effects is crucial. This comprehensive approach ensures that the benefits of these treatments are maximised while minimising any discomfort or risks to the patient.

Strategies for Management

  1. Follow Proper Inhalation Techniques: Proper use of the nebuliser or inhaler device is crucial. Patients should be trained on the correct technique to ensure optimal delivery of the medication and to reduce the likelihood of irritation.
  2. Regular Device Maintenance: Keeping the nebuliser or inhaler clean and well-maintained is vital. This prevents contamination and ensures the medication is delivered effectively.
  3. Hydration and Oral Care: Staying well-hydrated and rinsing the mouth after each nebulisation can help alleviate throat irritation and reduce the risk of oral thrush.
  4. Managing Cough and Throat Irritation: Using saline nebulisers, humidifiers, or throat lozenges can help soothe throat irritation and cough.
  5. Monitoring and Reporting Side Effects: Patients should be encouraged to monitor for any side effects and report them to their healthcare provider. This allows for timely adjustments in therapy if needed.
  6. Dosage Adjustments: If side effects are significant, healthcare providers may consider adjusting the dosage or frequency of the antibiotic therapy.
  7. Use of Additional Medications: In some cases, additional medications like bronchodilators, cough suppressants, or anti-inflammatory drugs may be prescribed to manage specific side effects.
  8. Regular Medical Review: Regular follow-ups with healthcare providers are essential to monitor the patient’s response to treatment and make any necessary adjustments.

In conclusion, nebulised antibiotics such as Colomycin, Gentamicin, Aztreonam, Tobramycin, and Meropenem play a pivotal role in suppressing chronic lung infections caused by Pseudomonas aeruginosa and other bacteria in non-CF bronchiectasis. Despite their off-license or off-label use, these antibiotics have demonstrated significant promise in reducing exacerbation frequency and enhancing the quality of life for individual patients.

These treatments target the bacteria directly at the source within the lungs, offering a more focused and often more effective means of managing persistent infections. This approach can lead to fewer flare-ups, better lung function, and an overall improvement in daily living for those affected by this chronic condition.

It’s important to note that access to these nebulised antibiotics can vary. They are available through specialist NHS centres, but not all are funded by the NHS for patients with non-CF bronchiectasis. This means that availability might depend on specific NHS trust policies and individual patient circumstances.

Ongoing clinical trials continue to investigate the efficacy and safety of these treatments in non-CF bronchiectasis. These studies are crucial for refining treatment strategies, understanding long-term effects, and potentially expanding access to these important medications.

Disclaimer: The information provided in this article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment

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