Liposomal Amikacin (Arikace™) in the Treatment of Lower Respiratory Tract Escherichia Coli in A Patient with Cystic Fibrosis

Objective Aerosolized antibiotics are directed against Pseudomonas aeruginosa in cystic fibrosis (CF). E. coli decolonization was attempted in a colonized CF patient with multiple IV and oral drugs, including aminoglycosides, cephalosporins, and carbapenems prior to the use of Arikace™. We hypothesized that novel drug formulation nebulized liposomal Amikacin (Arikace™) will eliminate E‐coli from the lower airways. Methods Four Arikace™ treatment cycles were administered over a 7 month period in three treatment cycles of 28 d, and the fourth of 56 d. A non‐treatment cycle of 28 d was observed between each of the treatment cycles. Results Quantitative analysis of sputum confirmed a reduction in the bacterial load of one strand of E.coli from 2.4 x 10E6 cfu/gram to 1.0–10E3 cfu/gram. The density of a second strand of E. coli increased from16 x 10E6 cfu/gram to 18 x 10E6 cfu/gram post‐treatment. Decreased levels of multiple other pathogens were observed. The patient's sputum mass decreased from a pre‐treatment value of 11.1 g to 4.66 g following treatment. Conclusions Arikace™ is a valuable tool to decrease E. coli infection of the lower airways.