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Effectiveness of a stepwise Pseudomonas aeruginosa eradication protocol in children with cystic fibrosis

Ana C Blanchard1, Eric Horton2, Sanja Stanojevic2

  • 1Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto M5G 1X8, Canada.

Journal of Cystic Fibrosis : Official Journal of the European Cystic Fibrosis Society
|February 13, 2017
PubMed

Insights

The initial step of antibiotic eradication therapy (AET) for Pseudomonas aeruginosa (Pa) in cystic fibrosis (CF) children is most effective. Subsequent AET steps show lower success rates, necessitating further research into optimal treatment strategies for Pa infections in CF.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Cystic Fibrosis Research

Background:

  • Antibiotic eradication therapy (AET) is standard for new Pseudomonas aeruginosa (Pa) infections in pediatric cystic fibrosis (CF) patients.
  • Limited data exists on AET effectiveness for patients failing initial treatment.
  • This study evaluates a multi-step AET protocol for new-onset Pa infections in children with CF.

Purpose of the Study:

  • To assess the effectiveness of a three-step AET protocol for new-onset Pa infections in pediatric CF patients.
  • To determine the success rates of individual steps and the overall protocol.
  • To identify optimal treatment strategies for Pa eradication in this population.

Main Methods:

  • Retrospective review of pediatric CF patients undergoing a three-step AET protocol (January 2010-December 2015).
  • Step 1: 28 days of inhaled tobramycin solution (TIS).
  • Step 2: Second course of TIS for persistent positive cultures.
  • Step 3: Intravenous antibiotics followed by TIS for subsequent positive cultures.

Main Results:

  • 128 patients experienced 213 new-onset Pa infections.
  • Step 1 achieved a 76.9% eradication rate in asymptomatic episodes.
  • Overall cumulative success rate for asymptomatic patients was 88.2%.
  • Subsequent steps (2 and 3) had stepwise success rates below 50%.

Conclusions:

  • The initial 28-day TIS course is the most successful AET step for new Pa infections in pediatric CF.
  • Eradication success rates decrease significantly with subsequent treatment attempts.
  • Further prospective studies are required to optimize AET strategies for pediatric CF patients with Pa infections.
Abstract

Keywords:
Antibiotic eradication therapyCystic fibrosisEradication failurePseudomonas aeruginosa infection

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