Oral antimicrobial use in outpatient cystic fibrosis pulmonary exacerbation management: A single-center experience

Elissa Charlotte Briggs, Thuan Nguyen, Michael Wall, Kelvin Macdonald

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Introduction: Cystic fibrosis (CF) pulmonary disease is characterized by intermittent episodes of acute lung symptoms known as 'pulmonary exacerbations'. While exacerbations are classically treated with parenteral antimicrobials, oral antibiotics are often used in 'mild' cases. Objectives: We determined how often management progressed to intravenous (IV) therapy. We also examined multiple courses of oral antimicrobials within one exacerbation, and identified patient factors associated with unsuccessful treatment. Methods: We performed a retrospective chart audit of oral antibiotic use in CF patients, from March 2009 through March 2010, for 'mild' CF exacerbations. Results: Administration of a single vs multiple courses of oral antibiotics for treatment of 'mild' CF exacerbation avoided progression to IV therapy 79.8% and 50.0% of the time, respectively. Overall, oral antibiotics circumvented the need for IV therapy 73.8% of the time. Using multi-variant analysis, we found multiple patient characteristics to be independent risk factors for oral antibiotic failure including a history of pseudomonas infection [odds ratio (OR) 2.13, confidence interval (CI) 1.29-3.54], CF-related diabetes (OR 1.85, CI 1.00-3.41), allergic Bronchopulmonary aspergillosis (OR 3.81, CI 1.38-10.56), low socioeconomic status (OR 1.67, CI 1.04-2.67), and calculated baseline forced expiratory volume in 1s (FEV 1) 1>10%, weight for age, body mass index, distance from the CF center and gender were not significant. Conclusion: Our observations suggest that one course of oral antimicrobials is frequently effective in outpatient CF pulmonary exacerbations but exacerbations requiring more than one course of oral antibiotics are likely to require IV therapy.

Original languageEnglish (US)
Pages (from-to)56-64
Number of pages9
JournalClinical Respiratory Journal
Volume6
Issue number1
DOIs
StatePublished - Jan 2012

Fingerprint

Cystic Fibrosis
Outpatients
Anti-Bacterial Agents
Odds Ratio
Confidence Intervals
Therapeutics
Allergic Bronchopulmonary Aspergillosis
Pseudomonas Infections
Lung
Forced Expiratory Volume
Social Class
Lung Diseases
Body Mass Index
Weights and Measures

Keywords

  • Antibiotics
  • Cystic fibrosis
  • Exacerbation
  • Pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Immunology and Allergy
  • Genetics(clinical)

Cite this

Oral antimicrobial use in outpatient cystic fibrosis pulmonary exacerbation management : A single-center experience. / Briggs, Elissa Charlotte; Nguyen, Thuan; Wall, Michael; Macdonald, Kelvin.

In: Clinical Respiratory Journal, Vol. 6, No. 1, 01.2012, p. 56-64.

Research output: Contribution to journalArticle

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abstract = "Introduction: Cystic fibrosis (CF) pulmonary disease is characterized by intermittent episodes of acute lung symptoms known as 'pulmonary exacerbations'. While exacerbations are classically treated with parenteral antimicrobials, oral antibiotics are often used in 'mild' cases. Objectives: We determined how often management progressed to intravenous (IV) therapy. We also examined multiple courses of oral antimicrobials within one exacerbation, and identified patient factors associated with unsuccessful treatment. Methods: We performed a retrospective chart audit of oral antibiotic use in CF patients, from March 2009 through March 2010, for 'mild' CF exacerbations. Results: Administration of a single vs multiple courses of oral antibiotics for treatment of 'mild' CF exacerbation avoided progression to IV therapy 79.8{\%} and 50.0{\%} of the time, respectively. Overall, oral antibiotics circumvented the need for IV therapy 73.8{\%} of the time. Using multi-variant analysis, we found multiple patient characteristics to be independent risk factors for oral antibiotic failure including a history of pseudomonas infection [odds ratio (OR) 2.13, confidence interval (CI) 1.29-3.54], CF-related diabetes (OR 1.85, CI 1.00-3.41), allergic Bronchopulmonary aspergillosis (OR 3.81, CI 1.38-10.56), low socioeconomic status (OR 1.67, CI 1.04-2.67), and calculated baseline forced expiratory volume in 1s (FEV 1) 1>10{\%}, weight for age, body mass index, distance from the CF center and gender were not significant. Conclusion: Our observations suggest that one course of oral antimicrobials is frequently effective in outpatient CF pulmonary exacerbations but exacerbations requiring more than one course of oral antibiotics are likely to require IV therapy.",
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N2 - Introduction: Cystic fibrosis (CF) pulmonary disease is characterized by intermittent episodes of acute lung symptoms known as 'pulmonary exacerbations'. While exacerbations are classically treated with parenteral antimicrobials, oral antibiotics are often used in 'mild' cases. Objectives: We determined how often management progressed to intravenous (IV) therapy. We also examined multiple courses of oral antimicrobials within one exacerbation, and identified patient factors associated with unsuccessful treatment. Methods: We performed a retrospective chart audit of oral antibiotic use in CF patients, from March 2009 through March 2010, for 'mild' CF exacerbations. Results: Administration of a single vs multiple courses of oral antibiotics for treatment of 'mild' CF exacerbation avoided progression to IV therapy 79.8% and 50.0% of the time, respectively. Overall, oral antibiotics circumvented the need for IV therapy 73.8% of the time. Using multi-variant analysis, we found multiple patient characteristics to be independent risk factors for oral antibiotic failure including a history of pseudomonas infection [odds ratio (OR) 2.13, confidence interval (CI) 1.29-3.54], CF-related diabetes (OR 1.85, CI 1.00-3.41), allergic Bronchopulmonary aspergillosis (OR 3.81, CI 1.38-10.56), low socioeconomic status (OR 1.67, CI 1.04-2.67), and calculated baseline forced expiratory volume in 1s (FEV 1) 1>10%, weight for age, body mass index, distance from the CF center and gender were not significant. Conclusion: Our observations suggest that one course of oral antimicrobials is frequently effective in outpatient CF pulmonary exacerbations but exacerbations requiring more than one course of oral antibiotics are likely to require IV therapy.

AB - Introduction: Cystic fibrosis (CF) pulmonary disease is characterized by intermittent episodes of acute lung symptoms known as 'pulmonary exacerbations'. While exacerbations are classically treated with parenteral antimicrobials, oral antibiotics are often used in 'mild' cases. Objectives: We determined how often management progressed to intravenous (IV) therapy. We also examined multiple courses of oral antimicrobials within one exacerbation, and identified patient factors associated with unsuccessful treatment. Methods: We performed a retrospective chart audit of oral antibiotic use in CF patients, from March 2009 through March 2010, for 'mild' CF exacerbations. Results: Administration of a single vs multiple courses of oral antibiotics for treatment of 'mild' CF exacerbation avoided progression to IV therapy 79.8% and 50.0% of the time, respectively. Overall, oral antibiotics circumvented the need for IV therapy 73.8% of the time. Using multi-variant analysis, we found multiple patient characteristics to be independent risk factors for oral antibiotic failure including a history of pseudomonas infection [odds ratio (OR) 2.13, confidence interval (CI) 1.29-3.54], CF-related diabetes (OR 1.85, CI 1.00-3.41), allergic Bronchopulmonary aspergillosis (OR 3.81, CI 1.38-10.56), low socioeconomic status (OR 1.67, CI 1.04-2.67), and calculated baseline forced expiratory volume in 1s (FEV 1) 1>10%, weight for age, body mass index, distance from the CF center and gender were not significant. Conclusion: Our observations suggest that one course of oral antimicrobials is frequently effective in outpatient CF pulmonary exacerbations but exacerbations requiring more than one course of oral antibiotics are likely to require IV therapy.

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