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Elective versus symptomatic intravenous antibiotic therapy for cystic fibrosis
1WISCH, Wirral Hospitals NHS Trust, Wirral, UK. lil.breen@whnt.nhs.uk
Background:
Pseudomonas aeruginosa is the commonest micro-organism associated with respiratory infections in cystic fibrosis. Retrospective studies have suggested that using an aggressive policy of intravenous anti-pseudomonal antibiotics at regular intervals, irrespective of symptoms, increases survival.
Objectives:
To determine whether there is evidence that an elective (regular) versus symptomatic intravenous antibiotic regimen is associated with an improvement in clinical status and survival rates in people with cystic fibrosis. To identify any adverse effects associated with the use of elective intravenous antibiotics, including an increase in the development of resistant organisms.
Search Methods:
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.Date of the most recent search of the Group's Cystic Fibrosis Trials Register: 15 March 2012.
Selection Criteria:
All randomised or quasi-randomised controlled trials describing the use of elective compared with symptomatic intravenous antibiotic policies for any duration or dose regimen. Elective versus symptomatic intravenous antibiotic regimens against any organisms were considered. People with cystic fibrosis of any age or disease severity were included.
Data Collection And Analysis:
Both authors independently assessed trial eligibility and quality; both extracted the data.
Main Results:
Searches identified four studies. Two studies reporting results from a total of 79 participants were included in the review. Differences in study design and objectives meant that data could not be pooled for meta-analysis. Neither study demonstrated significant differences in outcome measures between intervention and comparison groups.
Authors' Conclusions:
Studies are insufficient to identify conclusive evidence favouring a policy of elective intravenous antibiotic administration, despite its widespread use, neither are the potential risks adequately evaluated. The results should be viewed with caution, as participant numbers are small. Clearly there is a need for a well-designed, adequately-powered, multicentred randomised controlled trial to evaluate these issues.
Insights
Current evidence is insufficient to support elective intravenous antibiotics for cystic fibrosis patients. More research is needed to determine benefits and risks of this common treatment approach.
Area of Science:
- Medical research
- Clinical trials
- Infectious disease management
Background:
- Pseudomonas aeruginosa is a common cause of respiratory infections in cystic fibrosis patients.
- Retrospective studies suggest aggressive, regular intravenous anti-pseudomonal antibiotics may improve survival.
Purpose of the Study:
- To evaluate if elective (regular) versus symptomatic intravenous antibiotics improve clinical status and survival in cystic fibrosis.
- To identify adverse effects of elective antibiotics, including antibiotic resistance.
Main Methods:
- Searched Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register.
- Included randomized or quasi-randomized controlled trials comparing elective vs. symptomatic IV antibiotic policies.
- Two studies with 79 participants were included; data could not be pooled.
Main Results:
- Neither included study showed significant differences in outcomes between elective and symptomatic antibiotic groups.
- Data limitations prevented meta-analysis due to differing study designs and objectives.
Conclusions:
- Insufficient evidence supports elective intravenous antibiotic policies for cystic fibrosis.
- Potential risks, including antibiotic resistance, are not adequately evaluated.
- A well-designed, adequately-powered, multicenter randomized controlled trial is needed.
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