Location and Duration of Treatment of Cystic Fibrosis Respiratory Exacerbations Do Not Affect Outcomes

Collaco, Joseph M.; Green, Deanna M.; Cutting, Garry R.; Naughton, Kathleen M.; Mogayzel, Peter J.

doi:10.1164/rccm.201001-0057oc

Cited by 99 publications

(97 citation statements)

References 18 publications

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“…The study found that, despite longer duration of treatment, complete recovery of lost FEV1 did not happen with the extension of treatment. 15 The same study also did not show difference in FEV1 recovery according to the site of treatment (see below). Unlike our study, subjective parameters such as quality of life measures were not assessed.…”

Section: Discussionmentioning

confidence: 76%

Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations

Sequeiros

Jarad

2012

Chron Respir Dis

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Section: Discussionmentioning

confidence: 76%

Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations

Sequeiros

Jarad

2012

Chron Respir Dis

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“…antibiotics used to treat a pulmonary exacerbation. In contrast to studies where FEV1 was used as the primary outcome, which consistently showed a positive treatment effect [23][24][25][26], studies using LCI as an outcome measure have yielded heterogeneous results [13,[27][28][29][30]. The reasons why this is the case when LCI is used as the primary outcome measure are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Lung clearance index in cystic fibrosis subjects treated for pulmonary exacerbations

et al. 2015

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Pulmonary exacerbations are important clinical events for cystic fibrosis (CF) patients. Studies assessing the ability of the lung clearance index (LCI) to detect treatment response for pulmonary exacerbations have yielded heterogeneous results. Here, we conduct a retrospective analysis of pooled LCI data to assess treatment with intravenous antibiotics for pulmonary exacerbations and to understand factors explaining the heterogeneous response.A systematic literature search was performed to identify prospective observational studies. Factors predicting the relative change in LCI and spirometry were evaluated while adjusting for within-study clustering.Six previously reported studies and one unpublished study, which included 176 pulmonary exacerbations in both paediatric and adult patients, were included. Overall, LCI significantly decreased by 0.40 units (95% CI −0.60-−0.19, p=0.004) or 2.5% following treatment. The relative change in LCI was significantly correlated with the relative change in forced expiratory volume in 1 s (FEV1), but results were discordant in 42.5% of subjects (80 out of 188). Higher (worse) baseline LCI was associated with a greater improvement in LCI (slope: −0.9%, 95% CI −1.0-−0.4%).LCI response to therapy for pulmonary exacerbations is heterogeneous in CF patients; the overall effect size is small and results are often discordant with FEV1. @ERSpublications Lung clearance index response to therapy for pulmonary exacerbations is heterogeneous in cystic fibrosis patients http://ow.ly/Mnvtd

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“…antibiotics occurs in the first week of treatment, with little additional benefit being achieved by extending treatment beyond this point [14,15]. Unfortunately, these studies did not assess the relationship between clinical improvement and microbiological response and their findings have not been considered sufficiently robust to change clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Pyrosequencing reveals transient cystic fibrosis lung microbiome changes with intravenous antibiotics

et al. 2014

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Chronic airway infection in adults with cystic fibrosis (CF) is polymicrobial and the impact of intravenous antibiotics on the bacterial community composition is poorly understood. We employed culture-independent molecular techniques to explore the early effects of i.v. antibiotics on the CF airway microbiome.DNA was extracted from sputum samples collected from adult subjects with CF at three time-points (before starting treatment, and at day 3 and day 8-10 of i.v. antibiotics) during treatment of an infective pulmonary exacerbation. Microbial community profiles were derived through analysis of bacterial-derived 16S ribosomal RNA by pyrosequencing and changes over time were compared. 59 sputum samples were collected during 24 pulmonary exacerbations from 23 subjects. Between treatment onset and day 3 there was a significant reduction in the relative abundance of Pseudomonas and increased microbial diversity. By day 8-10, bacterial community composition was similar to pre-treatment. Changes in community composition did not predict improvements in lung function.The relative abundance of Pseudomonas falls rapidly in subjects with CF receiving i.v. antibiotic treatment for a pulmonary exacerbation and is accompanied by an increase in overall microbial diversity. However, this effect is not maintained beyond the first week of treatment. @ERSpublications Changes in the CF microbiome in response to i.v. antibiotics are not sustained despite ongoing antibiotic pressure

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Location and Duration of Treatment of Cystic Fibrosis Respiratory Exacerbations Do Not Affect Outcomes

Cited by 99 publications

References 18 publications

Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations

Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations

Lung clearance index in cystic fibrosis subjects treated for pulmonary exacerbations

Pyrosequencing reveals transient cystic fibrosis lung microbiome changes with intravenous antibiotics

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