Ceftobiprole in cystic fibrosis: a case series

Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the CF transmembrane conductance (CFTR) gene, resulting in the secretion of hyperviscous mucus. Infective exacerbations are a major determinant of morbidity and mortality in CF patients. These infections are clinically challenging, and antimicrobial treatment should effectively target the organisms and be delivered early to improve survival. Ceftobiprole is a fifth-generation cephalosporin antibiotic that is not indicated for the treatment of CF. However, due to its activity against common causes of infective exacerbations in CF such as Staphylococcus aureus, including MRSA, and Pseudomonas aeruginosa where resistance has not developed, it has utility for managing infective exacerbations.

To describe the use of ceftobiprole in the treatment of infective exacerbations in CF.

Ten patients with CF (age 24-63; six male and four female) were treated with ceftobiprole for infective exacerbations following discussion within the multi-disciplinary team. In most patients, ceftobiprole was given concomitantly with other antibiotics.

All patients had positive sputum cultures for S. aureus (including nine MRSA), and seven patients had concomitant P. aeruginosa infection. Ceftobiprole treatment was associated with improved lung function, and markers of systemic inflammation decreased for most patients, with some variation. There was good tolerability in all but four patients.

Ceftobiprole presents a therapeutic option for susceptible infections in CF patients with limited treatment options. Its broad-spectrum coverage may help to reduce polypharmacy. However, further clinical studies are needed.