Treatment of pseudomonas and Staphylococcus bronchopulmonary infection in patients with cystic fibrosis.
The optimal antibiotic regimen is unclear in management of pulmonary infections due to pseudomonas and staphylococcus in cystic fibrosis (CF). We systematically searched all the published literature that has considered the evidence for antimicrobial therapies in CF till June 2013. The key findings were as follows: inhaled antipseudomonal antibiotic improves lung function, and probably the safest/most effective therapy; antistaphylococcal antibiotic prophylaxis increases the risk of acquiring P. aeruginosa; azithromycin significantly improves respiratory function after 6 months of treatment; a 28-day treatment with aztreonam or tobramycin significantly improves respiratory symptoms and pulmonary function; aztreonam lysine might be superior to tobramycin inhaled solution in chronic P. aeruginosa infection; oral ciprofloxacin does not produce additional benefit in those with chronic persistent pseudomonas infection but may have a role in early or first infection. As it is difficult to establish a firm recommendation based on the available evidence, the following factors must be considered for the choice of treatment for each patient: antibiotic related (e.g., safety and efficacy and ease of administration/delivery) and patient related (e.g., age, clinical status, prior use of antibiotics, coinfection by other organisms, and associated comorbidities ones).
Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar 751019, India.
Rashmi Ranjan
RR
Das
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
Sushil Kumar
SK
Kabra
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Meenu
M
Singh
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D018849:Controlled Clinical Trials as Topic; D003550:Cystic Fibrosis / Q000150:complications*; D004333:Drug Administration Routes; D006801:Humans; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology; D012042:Registries; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology
D000900:Anti-Bacterial Agents