title: Utilization of antibiotics for methicillin-resistant Staphylococcus aureus infection in cystic fibrosis.
abstract: OBJECTIVE
  The purpose of this study was to characterize the utilization of antibiotics for chronic methicillin-resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis (CF) patients with acute pulmonary exacerbations (PEx).
  
  
  METHODS
  An anonymous national cross-sectional survey of CF Foundation accredited care programs was performed using an electronic survey tool.
  
  
  RESULTS
  Fifty-eight percent (152/261) CF Foundation accredited programs completed the survey. Ninety-eight percent (149/152) of respondents reported using antibiotics (oral or intravenous) against MRSA. Variability exists in the use of antibiotics amongst the programs and in the dosages utilized. For oral outpatient treatment, sulfamethoxazole/trimethoprim was the most commonly utilized antibiotic by both pediatric (109/287, 38%) and adult (99/295, 34%) respondents, of which, ten percent of reported to use it in combination with rifampin. For inpatient treatment, linezolid (both intravenous (IV) and oral) was most commonly utilized in both pediatric (IV 35/224, 16%; oral 41/224, 18%), and adult (IV 44/235, 19%; oral 38/235, 16%) respondents for inpatient treatment. IV vancomycin was the second most commonly utilized antibiotic by pediatric (70/224, 31%) and adult (71/235, 30%) respondents. Most respondents reported dose titration to achieve a vancomycin trough level of 15-20 mg/L (150/179, 84%). Topical or inhaled antibiotic utilization was reported to be an uncommon practice with approximately 70% of pediatric and adult respondents reporting to use them either rarely or never. The concomitant use of anti-MRSA and anti-pseudomonal antibiotics was common with 96% of pediatric and 99% of adult respondents answering in the affirmative.
  
  
  CONCLUSIONS
  We conclude that anti-MRSA antibiotics are utilized via various dosage regimens by a majority of CF Foundation accredited care programs for the treatment of chronic MRSA in PEx, and there is no consensus on the best treatment approach.
authors.affiliation: Department of Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah.|Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah.
authors.forename: Jeffery T
authors.initials: JT
authors.lastname: Zobell
authors.affiliation: Department of Pharmacy, St. Vincent's Medical Center Riverside, Jacksonville, Florida.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Epps
authors.affiliation: L.S. Skaggs Pharmacy Institute Rm 4916, University of Utah College of Pharmacy, Salt Lake City, Utah.|Intermountain Cystic Fibrosis Adult Center, Salt Lake City, Utah.
authors.forename: David C
authors.initials: DC
authors.lastname: Young
authors.affiliation: Department of Pharmacy, Intermountain McKay-Dee Hospital Center, Ogden, Utah.
authors.forename: Madison
authors.initials: M
authors.lastname: Montague
authors.affiliation: Department of Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah.
authors.forename: Jared
authors.initials: J
authors.lastname: Olson
authors.affiliation: Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, Utah.
authors.forename: Krow
authors.initials: K
authors.lastname: Ampofo
authors.affiliation: Cystic Fibrosis Foundation, Bethesda, Maryland.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Chin
authors.affiliation: Cystic Fibrosis Foundation, Bethesda, Maryland.
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Marshall
authors.affiliation: Departments of Medicine and Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: Elliott
authors.initials: E
authors.lastname: Dasenbrook
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D003430:Cross-Sectional Studies; D003550:Cystic Fibrosis / Q000150:complications*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D019538:Health Care Surveys; D006801:Humans; D000069349:Linezolid / Q000627:therapeutic use; D055624:Methicillin-Resistant Staphylococcus aureus; D010818:Practice Patterns, Physicians'; D012293:Rifampin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000069349:Linezolid; D012293:Rifampin
keywords: MRSA; anti-staphylococcal antibiotics; infections