Oral, inhaled, and intravenous antibiotic choice for treating pulmonary exacerbations in cystic fibrosis

Jeffrey S. Wagener, Lawrence Rasouliyan, Donald R. Vandevanter, David J. Pasta, Warren E. Regelmann, Wayne J Morgan, Michael W. Konstan

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Rationale Patients with cystic fibrosis (CF) experience frequent pulmonary exacerbations (PExs). Clinicians manage these episodes of worsening signs and symptoms in a variety of ways. Objectives To characterize the antibiotic management and associated change in lung function following PExs. Methods We used 2003-2005 data from the Epidemiologic Study of Cystic Fibrosis to examine antibiotic treatment and the immediate and long-term lung function change associated with clinician reported PExs. Results A total of 45,374 PExs were reported in 13,194 unique patients. Most PExs (73%) were treated with oral antibiotics, while 39% were treated IV and 24% were treated with inhaled antibiotics. The likelihood of non-IV versus IV antibiotic treatment was associated with the patient's age, stage of lung disease, and magnitude of lung function drop prior to the PEx. Following treatment, the average improvement in the FEV1 was 3.4 ± 12.2% predicted with a greater (5.1 ± 12.7% predicted) improvement following IV antibiotic treatment than with non-IV treatment (2.0 ± 11.6% predicted). When the best FEV 1 from the year before was compared with 180 days following the PEx there was an average fall of 3.8 ± 10.5% predicted with little difference observed between antibiotic treatment routes. Patients with only one exacerbation during the 3-year study had a similar loss of lung function to patients with no reported exacerbations. Conclusion Clinicians treat the majority of PExs with oral antibiotics, particularly in younger, healthier patients. Pulmonary function improves with antibiotic therapy, however, PExs are associated with lung function deterioration over time.

Original languageEnglish (US)
Pages (from-to)666-673
Number of pages8
JournalPediatric Pulmonology
Volume48
Issue number7
DOIs
StatePublished - Jul 2013

Fingerprint

Cystic Fibrosis
Anti-Bacterial Agents
Lung
Therapeutics
Lung Diseases
Signs and Symptoms
Epidemiologic Studies

Keywords

  • antibiotics
  • cystic fibrosis
  • epidemiology
  • pulmonary exacerbation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Wagener, J. S., Rasouliyan, L., Vandevanter, D. R., Pasta, D. J., Regelmann, W. E., Morgan, W. J., & Konstan, M. W. (2013). Oral, inhaled, and intravenous antibiotic choice for treating pulmonary exacerbations in cystic fibrosis. Pediatric Pulmonology, 48(7), 666-673. https://doi.org/10.1002/ppul.22652

Oral, inhaled, and intravenous antibiotic choice for treating pulmonary exacerbations in cystic fibrosis. / Wagener, Jeffrey S.; Rasouliyan, Lawrence; Vandevanter, Donald R.; Pasta, David J.; Regelmann, Warren E.; Morgan, Wayne J; Konstan, Michael W.

In: Pediatric Pulmonology, Vol. 48, No. 7, 07.2013, p. 666-673.

Research output: Contribution to journalArticle

Wagener, JS, Rasouliyan, L, Vandevanter, DR, Pasta, DJ, Regelmann, WE, Morgan, WJ & Konstan, MW 2013, 'Oral, inhaled, and intravenous antibiotic choice for treating pulmonary exacerbations in cystic fibrosis', Pediatric Pulmonology, vol. 48, no. 7, pp. 666-673. https://doi.org/10.1002/ppul.22652
Wagener, Jeffrey S. ; Rasouliyan, Lawrence ; Vandevanter, Donald R. ; Pasta, David J. ; Regelmann, Warren E. ; Morgan, Wayne J ; Konstan, Michael W. / Oral, inhaled, and intravenous antibiotic choice for treating pulmonary exacerbations in cystic fibrosis. In: Pediatric Pulmonology. 2013 ; Vol. 48, No. 7. pp. 666-673.
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AB - Rationale Patients with cystic fibrosis (CF) experience frequent pulmonary exacerbations (PExs). Clinicians manage these episodes of worsening signs and symptoms in a variety of ways. Objectives To characterize the antibiotic management and associated change in lung function following PExs. Methods We used 2003-2005 data from the Epidemiologic Study of Cystic Fibrosis to examine antibiotic treatment and the immediate and long-term lung function change associated with clinician reported PExs. Results A total of 45,374 PExs were reported in 13,194 unique patients. Most PExs (73%) were treated with oral antibiotics, while 39% were treated IV and 24% were treated with inhaled antibiotics. The likelihood of non-IV versus IV antibiotic treatment was associated with the patient's age, stage of lung disease, and magnitude of lung function drop prior to the PEx. Following treatment, the average improvement in the FEV1 was 3.4 ± 12.2% predicted with a greater (5.1 ± 12.7% predicted) improvement following IV antibiotic treatment than with non-IV treatment (2.0 ± 11.6% predicted). When the best FEV 1 from the year before was compared with 180 days following the PEx there was an average fall of 3.8 ± 10.5% predicted with little difference observed between antibiotic treatment routes. Patients with only one exacerbation during the 3-year study had a similar loss of lung function to patients with no reported exacerbations. Conclusion Clinicians treat the majority of PExs with oral antibiotics, particularly in younger, healthier patients. Pulmonary function improves with antibiotic therapy, however, PExs are associated with lung function deterioration over time.

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