Evaluating the Impact of CFTR Modulator Therapy on Antibiotic Utilization: Insights From a Single Center...

Cystic fibrosis (CF) leads to chronic airway obstruction, inflammation, and infection, resulting in pulmonary exacerbations (PEx) that negatively impact lung function, quality of life, and mortality. The introduction of highly effective CFTR modulator therapy (HEMT) has improved outcomes in people with CF (pwCF), reducing the frequency of PEx and antibiotics. Using data from a single-center retrospective review and the Pediatric Health Information System (PHIS) database, this study evaluates the impact of HEMT on antibiotic utilization in pwCF.

A single-center, retrospective analysis was conducted comparing antibiotic use in the pre-ETI (2017-2019) and post-ETI (2020-2022) periods. Inclusion criteria were pwCF receiving care at for at least 1 year in both periods. Data on antibiotic agent, duration, and route of administration were collected. Additionally, a multicenter, retrospective study using the PHIS database was performed between January 2015 through June 2023, analyzing antibiotic utilization in hospitalized pwCF across multiple pediatric hospitals. Metrics included days of therapy (DOT) per 1000 patient days and length of stay.

In the single-center analysis, there was a 36.2% decrease in IV and 19.5% decrease in PO antibiotic use in the post-ETI period, with no change in treatment duration. In the PHIS analysis, antibiotic utilization decreased from the pre-ETI to post-ETI period, with reductions in anti-PsA and anti-MRSA agents and a decrease in length of stay. The median DOT per 1000 patient days decreased from 2257 (IQR: 1950, 2417) to 1710 (IQRL: 1371, 1909) (P < .001).

The introduction of HEMT has led to reduction in antibiotic utilization for PEx among pwCF, at a single center and across multiple institutions. This decrease in antibiotic use highlights the potential for antibiotic stewardship programs to reassess and optimize antibiotic management in pwCF. Additional research is needed to determine the optimal duration and choice of antibiotics in the context of HEMT, with the goal of minimizing antibiotic exposure and associated risks.