Antibiotic prophylaxis in infants and young children with cystic fibrosis: A randomized controlled trial

Stutman, Harris R.; Lieberman, Jay M.; Nussbaum, Eliezer; Marks, Melvin I.

doi:10.1067/mpd.2002.121930

Cited by 152 publications

(132 citation statements)

References 16 publications

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“…Early detection of another less common but equally virulent species, Burkholderia cepacia, also may be beneficial because prompt isolation of positive patients might reduce the frequency of patient-to-patient transmission (10). Prophylactic antibiotic treatment to delay the acquisition of S. aureus, however, may actually enable earlier colonization by P. aeruginosa (11).…”

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confidence: 99%

Breath sulfides and pulmonary function in cystic fibrosis

Kamboures

Blake

Cooper

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

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We have determined the concentrations of carbonyl sulfide (OCS), dimethylsulfide, and carbon disulfide (CS 2) in the breath of a group of cystic fibrosis (CF) patients and one of healthy controls. At the detection sensitivity in these experiments, room air always contained measurable quantities of these three gases. For each subject the inhaled room concentrations were subtracted from the timecoincident concentrations in exhaled breath air. The most significant differences between the CF and control cohorts in these breath-minus-room values were found for OCS. The control group demonstrated a net uptake of 250 ؎ 20 parts-per-trillion-byvolume (pptv), whereas the CF cohort had a net uptake of 110 ؎ 60 pptv (P ‫؍‬ 0.00003). Three CF patients exhaled more OCS than they inhaled from the room. The OCS concentrations in the CF cohort were strongly correlated with pulmonary function. The dimethylsulfide concentrations in breath were greatly enhanced over ambient, but no significant difference was observed between the CF and healthy control groups. The net (breath minus room) CS 2 concentrations for individuals ranged between ؉180 and ؊100 pptv. They were slightly greater in the CF cohort (؉26 ؎ 38 pptv) vs. the control group (؊17 ؎ 15 pptv; P ‫؍‬ 0.04). Lung disease in CF is accompanied by the subsistence of chronic bacterial infections. Sulfides are known to be produced by bacteria in various systems and were therefore the special target for this investigation. Our results suggest that breath sulfide content deserves attention as a noninvasive marker of respiratory colonization.bacterial emission ͉ early detection ͉ Pseudomonas aeruginosa ͉ carbonic anhydrase ͉ mucin sulfation

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confidence: 99%

Breath sulfides and pulmonary function in cystic fibrosis

Kamboures

Blake

Cooper

et al. 2005

Proc. Natl. Acad. Sci. U.S.A.

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“…16 . Um estudo multicêntrico, duplo-cego, randomizado e controlado por placebo concluiu que, apesar de o uso de profilaxia prolongada com cefalexina ter adiado a aquisição de S. aureus, por outro lado aumentou a colonização com P. aeruginosa e não apresentou benefício clinicamente significativo em crianças pequenas com FC 17 . Entretanto, a colonização crônica das vias aéreas na FC por P. aeruginosa é reduzida em regiões onde a terapia antiestafilocócica é administrada estritamente com base na necessidade, ao invés de profilaticamente 18 .…”

Section: Discussionunclassified

Early microbial colonization of cystic fibrosis patients identified by neonatal screening, with emphasis on Staphylococcus aureus

Souza¹,

Nogueira²,

Matos³

et al. 2006

J Pediatr (Rio J)

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Objectives: To assess bacterial colonization prospectively in patients with cystic fibrosis identified by neonatal screening. To assess susceptibility to antimicrobials and to perform the molecular typing of Staphylococcus aureus strains isolated from the oropharynx of patients during the study.Methods: Twenty-five cystic fibrosis patients receiving regular treatment at the Cystic Fibrosis Outpatient Clinic of Hospital de Clínicas of Universidade Federal do Paraná, Brazil, were included in the study. All patients were identified by trypsin-like immunoreactivity and their diagnosis was confirmed by two or more sweat tests. Oropharyngeal swabs were collected and cultured according to routine methods; bacterial colonies were phenotypically identified and their susceptibility to antimicrobials was tested. S. aureus isolates were submitted to molecular typing using pulsed-field gel electrophoresis.Results: Out of 234 oropharyngeal swabs, S. aureus was the most frequently isolated strain (76% of patients, 42% of swabs), followed by Pseudomonas aeruginosa (36% of patients, 16% of swabs) and Haemophilus spp. (76% of patients; 19% of swabs). Seventy-three isolates were obtained from 19 patients colonized with S. aureus, of which 18 were oxacillin-resistant (24.6%), isolated from two patients, with the same electrophoretic profiles as that of the Brazilian clone. The remaining oxacillin-sensitive isolates were distributed into 18 electrophoretic profiles. Conclusion:There was higher prevalence of S. aureus, with earlier isolation than other pathogens. Multi-sensitive isolates were distributed into different clones, characterizing non-transmissibility among community-acquired strains. The isolated oxacillin-resistant S. aureus showed identical electrophoretic profiles, probably acquired in hospital. P. aeruginosa was not so frequent in the studied population.

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“…(4) It is believed that the increase in the prevalence and the early appearance of P. aeruginosa colonization is due to the continuous use of the antibiotic therapy against the Staphylococcus aureus. Various studies discuss this hypothesis, with confirming findings in various research centers in Canada, (5) the USA, (6) Germany (7) and the United Kingdom. (8) In the 1970s and 1980s, the emphasis in the treatment was intravenous antibiotic therapy against infection with P. aeruginosa, and this treatment improved survival.…”

Section: Introductionmentioning

confidence: 85%

Deposição pulmonar de tobramicina inalatória antes e após fisioterapia respiratória e uso de salbutamol inalatório em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa

et al. 2009

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Objective: To evaluate whether respiratory therapy followed by the use of inhaled albuterol modifies the pulmonary deposition of inhaled tobramycin in patients with cystic fibrosis (CF) and whether pulmonary deposition correlates with disease severity or genotype. Methods: A prospective study was carried out including patients with CF older than 6 years of age and colonized with Pseudomonas aeruginosa. Exclusion criteria were pulmonary exacerbation, changes in therapy between the study phases and FEV 1 < 25%. All patients were submitted to pulmonary scintigraphy by means of a scintillation camera equipped with a low-energy all-purpose collimator in order to evaluate drug penetration following the administration of inhaled 99m Tc-tobramycin, as well as to pulmonary perfusion with 99m Tc-macroaggregated albumin (phase 1). One month later, the same procedure was performed following respiratory therapy and administration of inhaled albuterol (phase 2). Results: We included 24 patients (12 males) aged 5-27 years (mean ± SD: 12.85 ± 6.64 years). The Shwachman score (SS) was excellent/good in 8 patients, moderate/fair in 16 and poor in 0. Genotyping revealed that 7 patients were ΔF508 homozygotes, 13 were ΔF508 heterozygotes; and 4 presented other mutations. In all patients, lung deposition of tobramycin decreased in phase 2, especially in those with moderate/fair SS (p = 0.017) and in heterozygotes (p = 0.043). Conclusions:The use of a respiratory therapy technique and the administration of inhaled albuterol immediately prior to the use of inhaled tobramycin decreased the pulmonary deposition of the latter in CF patients, and this reduction correlates with disease severity and genotype.Keywords: Cystic fibrosis; Tobramycin; Respiratory therapy; Albuterol; Radionuclide imaging. ResumoObjetivo: Avaliar se a fisioterapia respiratória seguida do uso de salbutamol inalatório modifica a deposição pulmonar de tobramicina inalatória em pacientes com fibrose cística (FC) e se a deposição pulmonar apresenta correlação com a gravidade da doença ou com o genótipo. Métodos: Um estudo prospectivo foi realizado com pacientes com FC maiores de 6 anos e colonizados por Pseudomonas aeruginosa. Os critérios de exclusão foram exacerbação pulmonar, mudança terapêutica entre as fases do estudo e FEV 1 < 25%. Todos os pacientes foram submetidos à cintilografia pulmonar com câmara de cintilação com um colimador low energy all purpose para avaliar a penetração da droga após a inalação de tobramicina marcada com tecnécio ( 99m Tc-tobramicina), e à perfusão pulmonar com 99m Tc-macroagregados de albumina (fase 1). Após um mês, foi realizado o mesmo procedimento precedido de fisioterapia respiratória e administração de salbutamol inalatório (fase 2). Resultados: Foram incluídos 24 pacientes (12 masculinos) com idade variando de 5 a 27 anos (média ± dp: 12,85 ± 6,64 anos). O escore de Shwachman (ES) foi excelente/bom em 8 pacientes, moderado/regular em 8 e grave em 0. A genotipagem revelou que 7 pacientes eram ΔF508 homozigotos, 13 eram ΔF...

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Antibiotic prophylaxis in infants and young children with cystic fibrosis: A randomized controlled trial

Cited by 152 publications

References 16 publications

Breath sulfides and pulmonary function in cystic fibrosis

Breath sulfides and pulmonary function in cystic fibrosis

Early microbial colonization of cystic fibrosis patients identified by neonatal screening, with emphasis on Staphylococcus aureus

Deposição pulmonar de tobramicina inalatória antes e após fisioterapia respiratória e uso de salbutamol inalatório em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa

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