Cystic fibrosis: A review of pulmonary infections and interventions

Thomassen, Mary Jane; Demko, Catherine A.; Doershuk, Carl F.

doi:10.1002/ppul.1950030510

Cited by 78 publications

(60 citation statements)

References 134 publications

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“…The goal is to achieve trough levels of tobramycin below 2 µg/ml and peak levels in the upper part of the recommended range (i.e. > 8 µg/ml) [7].Although different ways to establish the optimal dosage of aminoglycosides in patients with cystic fibrosis have been suggested, including calculations based on body surface [5], lean body mass [8] and body weight [9], the general consensus has been that each new episode requires determination of trough and peak aminoglycoside levels.…”

Section: Discussionmentioning

confidence: 99%

Optimal Tobramycin Dosage in Patients with Cystic Fibrosis - Evidence for Predictability Based on Previous Drug Monitoring

Bartel¹,

Habash²,

Lugauer³

et al. 1999

Infection

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SummaryA retrospective analysis of files of patients with cystic fibrosis and pulmonary exacerbations was performed to investigate whether an individual dosage of tobramycin once established by serum level determination allows a reliable prediction of the adequate dosage in a consecutive exacerbation. All patients hospitalized ≥ 2 times between May 1997 and September 1998 with pulmonary exacerbation due to Pseudomonas aeruginosa infection susceptible to tobramycin were included. The initial dosage to tobramycin was 5 mg/kg body weight every 12 h followed by drug level determinations to establish the optimal dose. In a consecutive exacerbation the same dosage per kg body weight was used again and drug level determinations were repeated. Sixteen patients (six female = 38%) with a mean age of 24 years (median: 26 years, range: 9-33) were hospitalized for 49 pulmonary exacerbations (2-6 per patient, mean: 3, median: 2.5). During the first episode of tobramycin treatment in the study period all trough levels were < 2 µg/ml (median: 0.6) and the peak levels were 7.1-16.9 µg/ml (median: 11.9). In four patients the peak level was > 12 µg/ml. In 28 consecutive episodes the dosage of tobramycin was chosen based on optimal results of previous drug level monitoring and in 27 instances (96%) the previously established optimal dose was confirmed. In five consecutive episodes the tobramycin dosage had been increased erroneously and this resulted in abnormally high peak levels in three cases. These findings suggest that a safe and therapeutic tobramycin dosage in an individual patient with cystic fibrosis is predictable based on a previously established optimal dosage.

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Section: Discussionmentioning

confidence: 99%

Optimal Tobramycin Dosage in Patients with Cystic Fibrosis - Evidence for Predictability Based on Previous Drug Monitoring

Bartel¹,

Habash²,

Lugauer³

et al. 1999

Infection

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“…Plates are incubated at 358C in a 5% CO 2 atmosphere for 24 h. P. aeruginosa is easily identified by characteristic colony morphology and standard microbiological methods [21,22]. P. aeruginosa isolates may differ concerning their morphotypes including mucoid, smooth, rough, dwarf and small colony varieties, and morphological varieties from a single patient may differ in antibiotic susceptibility patterns [22,23]. However, different morphotypes mostly belong to a single genotype.…”

Section: Diagnosis Of Pseudomonas Aeruginosa Lung Infectionmentioning

confidence: 99%

“…For sputa containing susceptible isolates, testing the mixed culture may provide adequate susceptibility data with significant laboratory time and cost savings [23]. However, for sputa with resistant strains, the traditional method of testing isolated morphotypes may be more appropriate [23].…”

Section: Antibiotic Resistance Of Pseudomonas Aeruginosa In Cystic Fimentioning

confidence: 99%

“…However, for sputa with resistant strains, the traditional method of testing isolated morphotypes may be more appropriate [23].…”

Section: Antibiotic Resistance Of Pseudomonas Aeruginosa In Cystic Fimentioning

confidence: 99%

“…Several problems arise when P. aeruginosa susceptibility patterns against antibiotics are used for clinical treatment in CF patients: 1) multiple morphotypes with different antibiotic susceptibilities are often isolated from a single sputum sample [22,23]; 2) the conventional definition of antibiotic resistance, which is based on the comparison of serum drug levels and minimal inhibitory concentrations (MIC) in vitro does not apply to CF lung infections when treated with inhaled antibiotics [37]; 3) The biofilm mode of growth of P. aeruginosa requires 100±1,000 times the concentration of a certain antibiotic to be effective compared to its nonmucoid variant which is normally tested [38]. Nevertheless, for several antibiotics tested, nonmucoid isolates were more resistant than mucoid isolates [39].…”

Section: Antibiotic Resistance Of Pseudomonas Aeruginosa In Cystic Fimentioning

confidence: 99%

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Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus

Döring¹,

Conway²,

Heijerman³

et al. 2000

Eur Respir J

559

478

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Cystic fibrosis (CF) is the most common lethal hereditary disorder with autosomal recessive heredity in caucasians. The majority of CF patients suffer from chronic respiratory infection with the opportunistic bacterial pathogen Pseudomonas aeruginosa. No consensus among clinicians has been reached so far concerning antibiotic treatment against P. aeruginosa in CF patients.Consensus answers to 24 important questions in this context, based on current evidence, are presented, given by a panel of 34 European experts. Questions addressed and answered are: The diagnosis of P. aeruginosa lung colonization in CF; The impact of P. aeruginosa on the clinical state of CF patients; The assessment of P. aeruginosa susceptibility against antibiotics and the importance of these results for the clinician; The use of monotherapy versus combination therapy; The development of microbial resistance; The achievement of optimal airway concentrations; The effects of subinhibitory concentrations of antibiotics on P. aeruginosa; Statements on the pharmacokinetics of antibiotics in CF patients; Recommendations for doses and dosing intervals and length of treatment regimens; and Toxic side effects due to repeated antibiotic therapy was addressed.The expert panel answered further questions on the use of fluoroquinolones in children with CF, on the administration of nebulized antibiotics and whether prevention of P. aeruginosa lung colonization is possible in CF using antibiotic therapy.Problems of antibiotic therapy at home and in the hospital were addressed, a consensus statement on regular maintenance treatment, or treatment on demand, was given and different routes of administration of antibiotics were recommended for different clinical situations.Finally, the factors which determine the choice of the antibiotic, the dosage, and the duration of the treatment in cystic fibrosis patients were addressed and the design of future antibiotic studies in the context of Pseudomonas aeruginosa lung infection in cystic fibrosis patients were recommended. Eur Respir J 2000; 16: 749±767.

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Comparison of serum amyloid A and C‐reactive protein as indicators of lung inflammation in corticosteroid treated and non‐corticosteroid treated cystic fibrosis patients

Smith

Colombo

McDonald

1992

Clinical Laboratory Analysis

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Serum amyloid A (SAA) and C-reactive protein (CRP) levels were compared in 830 serum samples from 155 cystic fibrosis (CF) patients. Correlation coefficients were calculated for all samples (r = 0.73), for samples from non-corticosteroid treated (CFNS) patients (n = 698, r = 0.80), and for samples from corticosteroid treated (CFS) patients (n = 132, r = 0.35). SAA was the more sensitive indicator of pulmonary inflammation when SAA and CRP were compared to pulmonary function tests of 49 hospitalized patients at admission and discharge. CRP levels were significantly (p less than .05) lower at admission in CFS patients than in CFNS patients, whereas SAA levels were not significantly different between the two groups. All nine CFS patients hospitalized had elevated SAA levels (average 22 times above normal limits) at admission, while only six had elevated CRP levels (average 3.7 times above normal limits) at admission. In the 40 CFNS patients both SAA and CRP levels were significantly elevated at admission. In each case SAA and CRP levels declined as pulmonary functions improved with effective antimicrobial therapy. In three instances SAA levels increased during hospitalization while CRP levels did not. In each case, rising SAA levels indicated clinical deterioration associated with evolving resistance of P. aeruginosa which required a change in antibiotic therapy.

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Cystic fibrosis: A review of pulmonary infections and interventions

Cited by 78 publications

References 134 publications

Optimal Tobramycin Dosage in Patients with Cystic Fibrosis - Evidence for Predictability Based on Previous Drug Monitoring

Optimal Tobramycin Dosage in Patients with Cystic Fibrosis - Evidence for Predictability Based on Previous Drug Monitoring

Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus

Comparison of serum amyloid A and C‐reactive protein as indicators of lung inflammation in corticosteroid treated and non‐corticosteroid treated cystic fibrosis patients

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