The success of the different eradication therapy regimens for Pseudomonas aeruginosa in cystic fibrosis.
OBJECTIVE
Antibiotic therapy aimed at eradicating Pseudomonas aeruginosa (Pa), and improved regimens to treat chronic Pa infection have played a major role in increasing the median survival of patients with cystic fibrosis (CF). However, different clinical centres use varying eradication regimens. The aim of this study was to evaluate the efficacy of multiple eradication treatments against initial Pa infection and to determine the factors affecting the treatment success.


METHODS
This study was conducted at the Hacettepe University Department of Pediatric Pulmonology. We examined the demographic, clinical and microbiological data of 146 CF patients with first Pa isolation in sputum culture from all 630 patients with CF studied. We aimed to identify the factors that affected the eradication of Pa infection and assessed the success rates of the different eradication protocols used.


CONCLUSIONS
The mean age of the patients was 71·5 months (2 months-29 years) when Pa was first isolated; the mean duration from CF diagnosis to first Pa isolation was 40 months. The most common treatment choices consisted of 2 weeks of intravenous ceftazidim-amikacin for severe exacerbation or 3 months of inhaled gentamycin combined with 3 weeks of oral ciprofloxacin for mild exacerbation in asymptomatic patients. With these treatment regimens, eradication was observed in 47 patients (32%), intermittent colonization in 42 patients (28%) and chronic colonization in 57 patients (40%). Forced expiratory volume in 1 s decline was statistically significant in patients with chronic colonization (P = 0·006). Being older than 2 years of age or having symptoms at the first Pa isolation was negatively associated with the treatment success.


CONCLUSIONS
Early antibiotic treatment for Pa can eradicate the bacteria, prevent or delay the development of chronic colonization and improve the general health status. The acquisition of Pa at an older age and having symptoms at first isolation negatively affected the success of eradication. The use of intravenous antibiotics may increase the efficacy of therapy. Inhaled tobramycin for Pa eradication was approved for reimbursement in Turkey from August 2014. The relatively low eradication rate may be explained by a lack of reimbursement for inhaled tobramycin and colistin in our country during the study period.
Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
N
N
Emiralioglu
Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
E
E
Yalcin
Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
A
A
Meral
Department of Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
B
B
Sener
Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
D
D
Dogru
Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
U
U
Ozcelik
Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
N
N
Kiper
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications* / Q000382:microbiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007223:Infant; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult
D000900:Anti-Bacterial Agents
Pseudomonas aeruginosa; cystic fibrosis; early eradication; treatment