Temocillin in the treatment of Burkholderia cepacia infection in cystic fibrosis.
BACKGROUND
Infections due to Burkholderia cepacia complex (Bcc) strains increase morbidity and mortality in cystic fibrosis (CF). Some transplant centres reject Bcc infected patients. We reviewed the results in patients treated with i.v temocillin.


METHODS
Twenty-three patients who received 38 courses of temocillin (1988-1998) were identified from the CF database at Royal Brompton Hospital. In three patients' data were inadequate; therefore analysis was done in 20. Outcome was measured as improvement, deterioration or no change (compared to admission) in the following categories: clinical (temperature, dyspnoea, sputum volume, chest pain), physiological (FEV1, FVC, oxygen saturation) and inflammatory markers (WBC, ESR, CRP). Patients who improved in two categories were classified as having improved. Antibiotic sensitivities and outcome were recorded.


RESULTS
In 18 of 32 courses (56.25%) improvement occurred. The organism (Bcc) in eight patients' sputum became resistant (three died). The antibiotics was changed in five patients with Bcc strains sensitive to temocillin because of no improvement and one patient due to allergy (rash). The average time to the next i.v antibiotic was 41 days. Eight patients died (in three the Bcc strain was resistant to temocillin). Fourteen patients with Bcc were transplanted and eight patients survived. Another patient who developed Bcc infection post-operatively, failing to respond to temocillin.


CONCLUSIONS
These results suggest the potential benefit of i.v temocillin in CF patients with Bcc for exacerbations and at the time of transplantation.
Lekkas
Anastasios
A
Department of Cystic Fibrosis, Royal Brompton Hospital, Sydney Street, London, SW36NP, United Kingdom.
Gyi
Khin M
KM
Hodson
Margaret E
ME
D000293:Adolescent; D000328:Adult; D000617:Aminoglycosides / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019121:Burkholderia Infections / Q000188:drug therapy* / Q000382:microbiology; D016956:Burkholderia cepacia / Q000302:isolation & purification*; D003550:Cystic Fibrosis / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D010406:Penicillins; C031367:temocillin