Effectiveness of a stepwise Pseudomonas aeruginosa eradication protocol in children with cystic fibrosis.

Abstract

INTRODUCTION:

Antibiotic eradication therapy (AET) for initial Pseudomonas aeruginosa (Pa) infection is standard of care in children with cystic fibrosis (CF), but information is limited on treatment for patients who fail initial AET. The aim of this study was to evaluate the effectiveness of a multi-step protocol for AET for new-onset Pa infections in children with CF.

METHODS:

A three-step AET protocol which includes: (step 1) 28days of tobramycin inhalation solution (TIS) for new-onset Pa infection; (step 2) a second course of TIS for patients with positive respiratory tract culture after step 1; (step 3) 14days of intravenous antibiotics followed by 28days of TIS for patients with a subsequent positive culture. We conducted a retrospective review of all pediatric CF patients who underwent the eradication protocol between January 2010 and December 2015. The success rate of each step and of the overall protocol was recorded.

RESULTS:

During the study period, 128 patients had a total of 213 new-onset Pa infections. Of 195 asymptomatic episodes, 150 (76.9%, 95% CI 70.4; 82.6) cleared after step 1 and 12 cleared after step 2 (33.3% (95% CI 18.6; 50.9) stepwise success rate and 87.1% (95% CI 77.1; 88.1) cumulative success rate). Intravenous antibiotics followed by 28days of TIS were administered in 24 episodes; this was successful in 10 episodes (41.7%; 95% CI 22.1; 63.4). The regimen in asymptomatic patients failed in fourteen episodes (7.5%; 95% CI 4.2; 12.3) then considered chronically infected with Pa. Overall, the cumulative success rate of the asymptomatic arm was 88.2% (95% CI 82.8; 92.4).

CONCLUSION:

The first step of the AET protocol led to the greatest eradication success. Subsequent eradication attempts have a success rate below 50%. Prospective studies of eradication protocols for this population are needed to determine the most effective treatment strategy.

• Authors: Ana C Blanchard, Eric Horton, Sanja Stanojevic, Louise Taylor, Valerie Waters, Felix Ratjen
• Journal: Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society (J Cyst Fibros) Vol. 16 Issue 3 Pg. 395-400 (May 2017) ISSN: 1873-5010 [Electronic] Netherlands
• PMID: 28189634 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Age of Onset
• Anti-Bacterial Agents (administration & dosage, adverse effects, classification)
• Canada (epidemiology)
• Child
• Child, Preschool
• Clinical Protocols
• Cystic Fibrosis (diagnosis, drug therapy, microbiology)
• Drug Administration Routes
• Drug Administration Schedule
• Female
• Humans
• Infant
• Male
• Medication Therapy Management (statistics & numerical data)
• Program Evaluation
• Pseudomonas Infections (diagnosis, drug therapy, epidemiology)
• Pseudomonas aeruginosa (drug effects, isolation & purification)
• Retrospective Studies
• Risk Factors