Abstract
Background: Cystic fibrosis (CF) is associated with frequent pulmonary exacerbations which increase the mortality risk. Therefore, most CF patients are chronically colonized with respiratory pathogens, the most common being Pseudomonas aeruginosa. Multidrug-resistant organisms are a major problem in CF patients. It’s been hypothesized that continuous-infusion antipseudomonal beta-lactam therapy in CF maintains serum concentrations above the minimum inhibitory concentration of susceptible strains and is more likely than intermittent infusion to achieve optimal pharmacodynamic targets for some intermediate and resistant strains of P. aeruginosa. The most extensively studied antibiotic for continuous-infusion protocol in CF is ceftazidime, which has been shown to improve lung function (forced expiratory volume in 1 second and forced vital capacity) and to increase pulmonary exacerbation free time. There have been no studies to evaluate the cost effectiveness or impact on quality of life of continuous infusion versus intermittent infusion antibiotic therapy in patients with CF. Our study aims to investigate the effect of continuous-infusion antibiotic therapy on pulmonary function. Methods: Cross sectional study of CF patients who were admitted to our hospital with acute pulmonary exacerbations between 1/1/2010 and 12/31/2016 and received parenteral antibiotics. We investigated the effect of use of continuous versus intermittent infusion of intravenous antibiotics on the pulmonary function (FEV1% predicted). Results: Intermittent infusion protocol was found to have a very small advantage over continuous infusion protocol on pulmonary function; however this difference is not statistically significant (p=0.0049). The longer the duration of antibiotics, the slightly better the pulmonary function at the end of the treatment, but the difference was not significant (p=0.2543). Conclusions: Even though we could not draw meaningful conclusions from our data, we would like bring attention to this subject because it carries an important therapeutic value for CF patients.
Highlights
Cystic fibrosis (CF) patients commonly suffer infections from multidrug resistant organisms, which increases their risk of treatment failure as a result of inability to meet pharmacodynamic targets (time above the minimum inhibitory concentration (T > MIC))[1]
Continuous-infusion antibiotic therapy is believed to be more effective in achieving those targets for resistant organisms in comparison to intermittent infusion
Despite the promising results of studies comparing the two infusion protocols, there is insufficient evidence recommend the routine use of continuous infusion for patients with pulmonary exacerbations, which supports the position of the Cystic Fibrosis Foundation on this matter[4]
Summary
Cystic fibrosis (CF) patients commonly suffer infections from multidrug resistant organisms, which increases their risk of treatment failure as a result of inability to meet pharmacodynamic targets (time above the minimum inhibitory concentration (T > MIC))[1]. Continuous-infusion antibiotic therapy is believed to be more effective in achieving those targets for resistant organisms in comparison to intermittent infusion. It’s been hypothesized that continuous-infusion antipseudomonal beta-lactam therapy in CF maintains serum concentrations above the minimum inhibitory concentration of susceptible strains and is more likely than intermittent infusion to achieve optimal pharmacodynamic targets for some intermediate and resistant strains of P. aeruginosa. The most extensively studied antibiotic for continuous-infusion protocol in CF is ceftazidime, which has been shown to improve lung function (forced expiratory volume in 1 second and forced vital capacity) and to increase pulmonary exacerbation free time. There have been no studies to evaluate the cost effectiveness or impact on quality of life of continuous infusion versus intermittent infusion antibiotic therapy in patients with CF. The longer the duration of antibiotics, the slightly better the pulmonary function at the end of the treatment, but the difference was not significant (p=0.2543)
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