Shifting patterns of inhaled antibiotic use in cystic fibrosis.
BACKGROUND
Antibiotic inhalation has become widely accepted as a standard treatment for cystic fibrosis (CF) airway infection. We assessed the prevalence and context of inhaled antibiotic use in the North American CF population. Our working hypothesis was that a shift from acute to chronic use of inhaled antibiotics has coincided with increased prevalence of use among CF patients.


METHODS
Descriptive statistics were collected for 30,833 patients enrolled in the Epidemiologic Study of CF (ESCF) during 1996 through 2005. A multivariate analysis was performed on data from a subgroup of 18,021 patients enrolled in ESCF during 2003 through 2005.


RESULTS
The prevalence of inhaled antibiotic use in the North American CF population increased during 1996 through 2005 due to increased chronic use, while acute use to treat pulmonary exacerbations decreased. In 2005, 50% of CF patients used inhaled tobramycin and 9% used inhaled colistin chronically; most of the latter used both agents concurrently. Airway obstruction severity and airway infection status were predictors of inhaled antibiotic use.


CONCLUSIONS
Increased chronic use and decreased acute use of inhaled antibiotics presumably reflect a shift toward more proactive management of airway infections in the North American CF population. The effects of these usage patterns on long-term clinical outcomes and emergence of antibiotic-resistant Pseudomonas aeruginosa strains warrant further study.
Moskowitz
Samuel M
SM
Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington 98195-7740, USA. smoskow@u.washington.edu
Silva
Stefanie J
SJ
Mayer-Hamblett
Nicole
N
Pasta
David J
DJ
Mink
David R
DR
Mabie
Jenny A
JA
Konstan
Michael W
MW
Wagener
Jeffrey S
JS
D000280:Administration, Inhalation; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003091:Colistin / Q000008:administration & dosage*; D003550:Cystic Fibrosis / Q000150:complications*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000209:etiology*; D014031:Tobramycin / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D014031:Tobramycin; D003091:Colistin