title: Optimization of anti-pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: III. fluoroquinolones.
abstract: This review is the third installment in a comprehensive State of the Art series and aims to evaluate the use of fluoroquinolones in the management of P. aeruginosa infection in both children and adults with cystic fibrosis (CF). Oral and intravenous ciprofloxacin have been shown to be well-tolerated in the treatment of acute pulmonary exacerbations (APE) secondary to P. aeruginosa. Older literature supports an oral dosing regimen of 40 mg/kg/day divided every 12 hr, up to 2 g/day, and intravenous (IV) ciprofloxacin 30 mg/kg/day divided every 8 hr, maximum 1.2 g/day in children, and 750 mg administered orally twice a day or 400 mg IV every 8 hr in adults. However, a recent pharmacodynamic (PD) modeling study shows that the literature, U.S. Food and Drug Administration (FDA)-approved, and Cystic Fibrosis Foundation (CFF) guideline dosing regimens may be suboptimal for the treatment of P. aeruginosa in APE. Further study is warranted to determine if higher doses of ciprofloxacin are needed. Limited pharmacokinetic (PK), PK/PD, and efficacy studies involving levofloxacin exist in adult patients with CF. No pediatric data exists for levofloxacin in CF patients. Further study is needed to determine the tolerability and efficacy of levofloxacin in APE. At this time, the routine use of levofloxacin in the treatment of APE in pediatric and adult patients cannot be recommended.
authors.affiliation: Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, UT 84108, USA. chris.stockmann@hsc.utah.edu
authors.forename: Chris
authors.initials: C
authors.lastname: Stockmann
authors.forename: Catherine M T
authors.initials: CM
authors.lastname: Sherwin
authors.forename: Jeffery T
authors.initials: JT
authors.lastname: Zobell
authors.forename: David C
authors.initials: DC
authors.lastname: Young
authors.forename: C Dustin
authors.initials: CD
authors.lastname: Waters
authors.forename: Michael G
authors.initials: MG
authors.lastname: Spigarelli
authors.forename: Krow
authors.initials: K
authors.lastname: Ampofo
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003550:Cystic Fibrosis / Q000150:complications*; D018450:Disease Progression; D004334:Drug Administration Schedule; D006801:Humans; D007275:Injections, Intravenous; D064704:Levofloxacin; D015242:Ofloxacin / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D064704:Levofloxacin; D015242:Ofloxacin