The response pharmacists have given me is: The FDA has passed guidelines that say meds for inhalation must meet sterility standards that are very similar to standards for injected drugs. This is why its so difficult to find HS - few pharmacies have the sterile hood necessary to meet the guideline.
I know several pharmacists who agree that this is a flawed policy, because the body, even a CFer's body, is much more vulnerable to infection from injected things than inhaled things. They aren't saying that inhaled infection doesn't happen, just that the current guideline is unreasonably strict.
When you talk to your Dr. point out that in the past, like when Mucomyst was first used, that CFers were told by their CF docs to make their own saline solution on the stove, mixing boiling water, salt, and a small amont of baking soda to make the solution to mix with the mucomyst. I also remember my pharmacist when I was young (pre-TOBI) dumping all the single use injection vials of Gentamycin or Tobra into one big brown bottle that I would use for months, drawing out the meds with the same syringe day in and day out.
The changes that have occurred haven't come down because of infection problems from these practices.... at least I've never seen anything to suggest that. They happened when TOBI and other meds were finally formulated for a small particulate inhalation size, and without the same nasty preservatives that were used in the older, injection antibiotics.
It makes me so upset about how expensive the HS is - I mean really, 60+ dollars for salt water?????
Chris
26 m w/cf