Relationship of Antibiotic Treatment to Recovery after Acute FEV1Decline in Children with Cystic Fibrosis.
BACKGROUND
Children with cystic fibrosis often experience acute declines in lung function. We previously showed that such declines are not always treated with antibiotics, but we did not assess whether treatment improves the likelihood of recovery.


OBJECTIVE
To determine whether new antibiotic treatment was associated with recovery from acute FEV1decline.


METHODS
We studied episodes of FEV1decline (≥10% from baseline) in the Epidemiologic Study of Cystic Fibrosis. Treatments were hospitalization, home intravenous antibiotic, new inhaled oral quinolone, or other oral antibiotic. We used logistic regression to evaluate whether treatment was associated with recovery to baseline or near baseline.


RESULTS
Logistic regression of 9,875 patients showed that new antibiotic treatment was associated with an increased likelihood of recovery to 90% of baseline (P < 0.001), especially for hospitalization compared with no new antibiotic (odds ratio [OR], 2.79; 95% confidence interval, 2.41-3.23). All four outpatient treatments were associated with greater likelihood of recovery compared with no treatment (OR, 1.27-1.64). Inpatient treatment was better than outpatient treatment (OR, 1.94; 95% confidence interval, 1.68-2.23). Treatment-type ORs were similar across recovery criteria and levels of baseline lung function.


CONCLUSIONS
New antibiotic therapy, and especially inpatient treatment, is associated with greater likelihood of recovery after acute decline in FEV1. Benefits extend across all disease stages and are especially important in patients with high lung function, who are at greatest risk for FEV1decline.
1 Department of Pediatrics, The University of Arizona, Tucson, Arizona.
Wayne J
http://orcid.org/0000-0002-6346-8140
WJ
Morgan
2 Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Jeffrey S
JS
Wagener
3 ICON Clinical Research, San Francisco, California; and.
David J
http://orcid.org/0000-0003-2637-9293
DJ
Pasta
3 ICON Clinical Research, San Francisco, California; and.
Stefanie J
SJ
Millar
4 Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Donald R
http://orcid.org/0000-0002-5727-8164
DR
VanDevanter
4 Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Michael W
MW
Konstan
D000293:Adolescent; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications* / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000503:physiopathology; D008297:Male; D009656:North America / Q000453:epidemiology; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000453:epidemiology*; D015363:Quinolones / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D015363:Quinolones
adolescent; epidemiology; respiratory function tests; spirometry