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[Antibiotic treatment of cystic fibrosis]
M de Montalembert1, P Berche, G Lenoir
1Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Paris.
Abstract:
Lower respiratory tract superinfection is nearly constant in cystic fibrosis and has a significant impact on mortality. The three organisms which most often colonize the bronchial tree are Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa. The latter organism is found in 70% to 90% of older cystic fibrosis patients. P. aeruginosa infections are remarkably persistent and cause severe, extensive lung damage. Antimicrobial therapy is indicated in patients with clinical symptoms (fever, weight loss, changes in sputum and auscultation) and should be selected on the basis of cytobacteriologic studies of sputum. Oral antibiotics are usually successful in eradicating S. aureus and H. influenzae. Conversely, intravenous therapy is required in most cases of P. aeruginosa infection. Fifteen-day courses are given repeatedly, either on a routine basis every three months, or whenever new clinical symptoms develop. Antimicrobials usually fail to eradicate P. aeruginosa even when significant clinical improvement occurs. Two-drug therapy and judicious use of the various available anti-microbial agents should delay development of resistant strains, an event which is nearly inevitable as antimicrobial treatments are repeated.
Insights
Lower respiratory tract superinfections are common in cystic fibrosis (CF) patients. While oral antibiotics can treat Staphylococcus aureus and Haemophilus influenzae, Pseudomonas aeruginosa often requires intravenous therapy and is difficult to eradicate.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Microbiology
Context:
- Lower respiratory tract superinfections are nearly constant in cystic fibrosis (CF).
- Staphylococcus aureus, Haemophilus influenzae, and Pseudomonas aeruginosa are the most common colonizers.
- Pseudomonas aeruginosa infects 70-90% of older CF patients, causing persistent infections and severe lung damage.
Purpose:
- To outline the management of lower respiratory tract superinfections in cystic fibrosis patients.
- To highlight the challenges in eradicating Pseudomonas aeruginosa infections.
- To emphasize the importance of antimicrobial stewardship in preventing resistance.
Summary:
- Antimicrobial therapy is indicated for symptomatic CF patients, guided by sputum cytobacteriologic studies.
- Oral antibiotics are effective for S. aureus and H. influenzae, but P. aeruginosa typically requires intravenous therapy.
- Repeated antibiotic courses are often necessary for P. aeruginosa, but eradication is rare, and resistance development is nearly inevitable.
Impact:
- Effective management of bacterial infections is crucial for improving outcomes in cystic fibrosis.
- Understanding treatment challenges for P. aeruginosa is vital for developing new therapeutic strategies.
- Judicious antimicrobial use and combination therapy may delay the emergence of resistant strains.