No abstract

During the period 1965-79 191 cystic fibrosis patients have been treated with 2349 course of anti-staphylococcal chemotherapy in the Danish Cystic Fibrosis Centre. The standard treatment was orally administered Fusidic acid in combination with Oxacillin or Dicloxacillin given for 14 days. In cases of penicillin allergy Fusidic acid in combination with Rifampicin was given. The overall results showed that S. aureus was eradicated from sputum by a single course of chemotherapy in 74% of the cases, although in 8% the original strains (phage-type) was replaced by a new strain. Repeated or extended treatment was successful in most of the remaining cases and, as a result, only 9% of our patients harboured S. aureus continuously for 6 months or more. On the average each patient received 2 anti-staphylococcal treatment per year, but no decrease in efficacy of repeated treatment was seen. Likewise, no significant increase of S. aureus precipitins and no development of resistant strains was seen in our patients. Due to the efficacy of chemotherapy and the principles of early treatment whether there are clinical symptoms of infection or not, S. aureus infection is now considered a minor problem without relation to poor prognosis in our cystic fibrosis patients.

During the period 1971-75, 51 cystic fibrosis (CF) patients who contracted chronic P. aeruginosa infection were treated at the Danish CF centre with anti-pseudomonas chemotherapy only when their clinical condition deteriorated considerably. During the period 1976-80, 58 CF patients who contracted chronic P. aeruginosa infection were treated at the Danish CF centre with anti-pseudomonas chemotherapy on a regular basis every 3 months. Each routine 24 day-course of chemotherapy consisted of tobramycin in combination with carbenicillin or other beta-lactam antibiotics with activity against P. aeruginosa. In case of allergy or resistant strains monotherapy with tobramycin was used. The 5-year survival of CF patients from the time of the onset of the chronic P. aeruginosa infection increased from 54% in the first period to 82% in the second period (p less than 0.05), and lung function (peak expiratory flow rate) also improved significantly. It is concluded that intensive "maintenance" chemotherapy against P. aeruginosa improves survival and quality of life of CF patients although permanent eradication of P. aeruginosa is not accomplished.

Høiby, N., Friis, B., Jensen, K., Koch, C, Møller, N.E., Støvring, S. and Szaff, M. (Statens Seruminstitut, Departments of Clinical Microbiology at Rigshospitalet and Hvidovre Hospital, and Paediatric Department TG, Rigshospitalet, Copenhagen, Denmark). Antimicrobial chemotherapy in cystic fibrosis patients. Acta Paediatr Scand 1982; suppl 301: 75‐100. — Every effort should be undertaken to combat recurrent and chronic bacterial respiratory tract infections in patients with cystic fibrosis because infections are the main pathogenetic factors of lung damage in these patients. The principles and antibiotics used to treat bacterial infections in the Danish Cystic Fibrosis centre are outlined. The chemotherapy is based on microbiological diagnosis of secretions from the lower respiratory tract. S. aureus infections are efficiently treated with oral fusidic acid in combination with isoxazolyl penicillins or rifampicin in case of penicillin allergy or methicillin‐resistant S. aureus. H. influenzae infections are treated efficiently with oral pivampicillin or amoxicillin or with erythromycin sometimes in combination with rifampicin in case of penicillin allergy or ampicillin‐resistant H. influenzae. As a result of the efficient chemotherapy S. aureus and H. influenzae infections are now minor problems generally not related to prognosis of cystic fibrosis patients. Chronic P. aeruginosa infections are treated regularly four times per year with intravenous anti‐pseudomonas β‐lactam antibiotics in combination with tobramycin. P. aeruginosa is rarely permanently eradicated by this treatment, but significantly improved survival of the patients is obtained. The problems of resistant bacterial strains, allergy, and other side effects caused by the antibiotics are discussed.