[Tolerance and efficacy of ceftazidime in combination with aztreonam for exacerbations of cystic fibrosis].
BACKGROUND
Antibiotic therapy for acute pulmonary exacerbations in patients with cystic fibrosis is usually chosen based on the results of antimicrobial susceptibility. This can be difficult when bacteria are multiresistant. The objective of this retrospective study was to evaluate the tolerance and efficiency of ceftazidime and aztreonam combination (+/-tobramycin, +/-ciprofloxacin) in the treatment of acute exacerbations in cystic fibrosis patients who were chronically colonized with multiresistant P. aeruginosa.


METHODS
Seventeen severe patients, with FEV(1)=1070+/-66 mL and BMI=18+/-0.6 kg/m(2), who had chronic colonisation with P. aeruginosa with intermediate sensitivity or resistance to ceftazidime and aztreonam, were studied between June 2003 and March 2007. Oxygen saturation, dyspnoea, weight, FEV(1), FVC, and tolerance were evaluated before and after antibiotic courses.


RESULTS
Forty-two courses of treatment, administered between June 2003 and March 2007 were studied: Patients increased their FEV(1) and FVC (p=0.01). One antibiotic course was stopped after four days because of cutaneous side effects. The median delay until the next exacerbation was 101+/-10 days. These courses were compared with other combinations of antibiotics that the patients had received before. The combination of ceftazidime and aztreonam was more effective in patients receiving less than four courses per year for acute pulmonary exacerbation.


CONCLUSIONS
In chronically P. aeruginosa colonised cystic fibrosis patients, ceftazidime and aztreonam combination (+/-tobramycin, +/-ciprofloxacin) is well tolerated and efficient. This treatment suggests a clinical and functional benefit is possible, even in patients with severe disease.
Prévotat
A
A
CRCM adultes, service de pneumologie et immuno-allergologie, hôpital Calmette, CHRU de Lille, boulevard du Professeur Leclercq, 59037 Lille, France. anneprevotat@hotmail.fr
Leroy
S
S
Perez
T
T
Wallet
F
F
Wallaert
B
B
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001398:Aztreonam / Q000009:adverse effects / Q000627:therapeutic use*; D002442:Ceftazidime / Q000009:adverse effects / Q000627:therapeutic use*; D003550:Cystic Fibrosis / Q000150:complications*; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000209:etiology*; D011550:Pseudomonas aeruginosa; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002442:Ceftazidime; D001398:Aztreonam