If you need an inhaled antibiotic for no longer than three months and you're prepared to take it twice a day and risk damage to your hearing and kidneys for a slightly better increase in lung function than you can get from once-daily Arikace - you'll choose Tobi.
But sadly there's nobody out there with Cystic Fibrosis who only needs antibiotics for three months.
By the end of the study Arikace was already delivering a greater reduction in bacterial density than Tobi, whose effect was never any better than negligible by the end of the off-therapy phases. Greater increase in lung function will inevitable follow greater decrease in bacterial density.
And Tobi is thought to have negligible efficacy against mycobacterial infection, whereas Arikace has now demonstrated at Phase III that it delivers amikacin to a pulmonary bacterial infection. Amikacin injection is already routinely used in the treatment of pulmonary infection by NTM and drug-resistant Mycobacterium Tuberculosis.
Over 100,000 in the US/Europe are treated for pulmonary NTM infection each year, currently with off-label therapies because nothing has ever been approved for NTM. That was the reason (or perhaps the excuse) for the NIAID to propose and conduct the ongoing Arikace NTM clinical trial.
With regard to the potential use of Arikace as a therapy for drug-resistant Tuberculosis I'll allow your imagination to conjure up an appropriate nightmare Terry :-)