Pari sinus

Question

Dear expert team,
which experience is present with an 11-year-old and the PARI SINUS (no adenoids but often greenish, viscous mucous and chron. Pseudomonas aeruginosa):
Can also Tobramycin be inhaled in case of infection (if yes in what dosage) or other drugs??
Many thanks for your advice.

Answer

Hello,
until now there are only single-case reports on the antibiotic inhalation via the Pari Sinus in CF patients. Some patients do inhale with it for weeks and months and have tolerated it in general well. On the ERCF-congress in Brest we have reported a patient with primary colonization with Pseudomonas - only in the upper airways, who is since a 4-weeks sinunasal inhalation therapy pseudmonas-free for more than 2.5 years in both airway etages.
In order to investigate the security and efficacy of this new therapeutic concept, we conduct at the moment controlled studies with 80mg Tobramycin as well as with 1 Mio. IE Colistin via the sinus (inhalation duration about 4 minutes per nostril each). Especially for higher dosages of antibiotics, investigations for security are necessary.
In general, patients over the age of 8 years can inhale with the system. For the sinus inhalation, the smooth gums has to be as closed as with the usual nose shower, with which secretions and crust are removed (nasal lavage with about 125 ml NaCl per nostril). The sinus inhalation can therefore be done easily by all patients, which master the lavage well. During the inhalation, the contralateral nostril is closed with a plug or a finger-tip; inhalations are performed in the phase of holding the breath.
In case the inhalation is performed correctly, one feels a vibration over the root of the nose or over the sinuses.
Beneath antibiotics, of course drugs to mobilize the mucus can be inhaled sinu-nasally. Also these therapeutic measures are investigated by us systemically at the moment.
Yours sincerely,
Dr. J. Mainz

03.08.2009