Cystic Fibrosis Pulmonary Guidelines

Flume, Patrick A.; Mogayzel, Peter J.; Robinson, Karen A.; Goss, Christopher H.; Rosenblatt, Randall L.; Kuhn, Robert J.; Marshall, Bruce C.

doi:10.1164/rccm.200812-1845pp

Cited by 646 publications

(249 citation statements)

References 65 publications

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“…The use of continuous infusion compared to intermittent infusion of beta-lactams in the treatment of APE remains a matter of controversy. In 2009, the CF Foundation (Bethesda, MD) concluded that there is insufficient evidence to recommend the first option (21). In 2011, Prescott et al evaluated the pharmacokinetics, efficacy, safety, stability, pharmacoeconomics, and quality-of-life effects of continuous-infusion antipseudomonal ␤-lactam therapy in patients with CF.…”

Section: Discussionmentioning

confidence: 99%

How To Minimize Toxic Exposure to Pyridine during Continuous Infusion of Ceftazidime in Patients with Cystic Fibrosis?

Bourget¹,

Amin

Dupont³

et al. 2014

Antimicrob Agents Chemother

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Ceftazidime is particularly efficient against Pseudomonas aeruginosa in cystic fibrosis patients. Thus, the spontaneous production of pyridine, which is a toxic product, raises some concern. Our aim was to examine the kinetics of degradation of ceftazidime in portable infusion pumps either at 4°C, 22°C, or 33°C and to propose some recommendations in order to reduce the pyridine exposure. Two administration models were studied in vitro. In model 1, we administered 12 g of ceftazidime infused over 23 h (once-daily infusion) compared to 6 g infused over 11.5 h in model 2 (twice-daily regimen). Samples were collected at 0 h and then every 4 and 2 h after the shaping of portable infusion pumps in models 1 and 2, respectively. Both ceftazidime and pyridine were analyzed using an ultraviolet high-performance liquid chromatograph. Production of pyridine is highly depending on the temperature. The in situ production of pyridine per day of treatment decreases at a ratio close to 1/6 and 1/3 between 33°C and 4°C in models 1 and 2, respectively. Regardless of the conditions, the production of pyridine is significantly lower in model 2, whereas the total delivery amount of ceftazidime is significantly higher at 4°C and 33°C compared to that in model 1. According to a the precautionary principle, these findings lead to three major recommendations: (i) exposing a solution of ceftazidime to over 22°C should be strictly avoided, (ii) a divided dose of 6 g over 11.5 h instead of a once-daily administration is preferred, and (iii) infusion should be administered immediately after reconstitution.

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Section: Discussionmentioning

confidence: 99%

How To Minimize Toxic Exposure to Pyridine during Continuous Infusion of Ceftazidime in Patients with Cystic Fibrosis?

Bourget¹,

Amin

Dupont³

et al. 2014

Antimicrob Agents Chemother

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“…In the final analysis, the authors concluded that there was no difference between the groups in treatment failure rate, changes in lung function, dyspnea, or bacterial density. Based almost entirely on these findings, the 2009 Cystic Fibrosis Foundation practice guidelines specifically stated that synergy testing should not be done in cystic fibrosis patients (25). This sentiment is certainly supported by a 2007 review claiming that synergy testing should not be performed in cystic fibrosis patients (26).…”

Section: Cystic Fibrosis and Synergy Testingmentioning

confidence: 99%

When Does 2 Plus 2 Equal 5? A Review of Antimicrobial Synergy Testing

2014

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In this age of emerging antibiotic resistance, limited therapeutic options exist for treating multidrug-resistant organisms. Combination therapy is commonly employed to manage these infections despite little laboratory guidance as to the efficacy of this approach. Synergy testing methods have been used to assess the interaction of antibiotic combinations in vitro. This review will discuss the four primary methods used to assess synergy, as well as the data that exist for testing of cystic fibrosis. In the final analysis, this review concludes that there is not enough evidence to endorse synergy testing for routine clinical use.

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“…Acute pulmonary exacerbations and chronic infections due to Pseudomonas aeruginosa, Achromobacter xylosoxidans, and Stenotrophomonas maltophilia may result in decreases in pulmonary function and high morbidity and mortality rates among CF patients (3)(4)(5). It was shown that multidrug-resistant (MDR) P. aeruginosa strains were associated with accelerated progression of CF and unfavorable outcomes (6).…”

mentioning

confidence: 99%

In Vitro Activity of Ceftolozane-Tazobactam against Multidrug-Resistant Nonfermenting Gram-Negative Bacilli Isolated from Patients with Cystic Fibrosis

Grohs

Taieb

Morand

et al. 2017

Antimicrob Agents Chemother

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Ceftolozane-tazobactam was tested against 58 multidrug-resistant nonfermenting Gram-negative bacilli (35 Pseudomonas aeruginosa, 11 Achromobacter xylosoxydans, and 12 Stenotrophomonas maltophilia isolates) isolated from cystic fibrosis patients and was compared to ceftolozane alone, ceftazidime, meropenem, and piperacillin-tazobactam. Ceftolozane-tazobactam was the most active agent against P. aeruginosa but was inactive against A. xylosoxydans and S. maltophilia. In time-kill experiments, ceftolozane-tazobactam had complete bactericidal activity against 2/6 clinical isolates (33%).

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Cystic Fibrosis Pulmonary Guidelines

Cited by 646 publications

References 65 publications

How To Minimize Toxic Exposure to Pyridine during Continuous Infusion of Ceftazidime in Patients with Cystic Fibrosis?

How To Minimize Toxic Exposure to Pyridine during Continuous Infusion of Ceftazidime in Patients with Cystic Fibrosis?

When Does 2 Plus 2 Equal 5? A Review of Antimicrobial Synergy Testing

In Vitro Activity of Ceftolozane-Tazobactam against Multidrug-Resistant Nonfermenting Gram-Negative Bacilli Isolated from Patients with Cystic Fibrosis

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