Premium
Optimization of anti‐pseudomonal antibiotics for cystic fibrosis pulmonary exacerbations: III. fluoroquinolones
Author(s) -
Stockmann Chris,
Sherwin Catherine M.T.,
Zobell Jeffery T.,
Young David C.,
Waters C. Dustin,
Spigarelli Michael G.,
Ampofo Krow
Publication year - 2013
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.22667
Subject(s) - medicine , levofloxacin , cystic fibrosis , ciprofloxacin , tolerability , dosing , pharmacokinetics , antibiotics , pharmacodynamics , regimen , guideline , pharmacology , adverse effect , pathology , microbiology and biotechnology , biology
Abstract This review is the third installment in a comprehensive State of the Art series and aims to evaluate the use of fluoroquinolones in the management of P. aeruginosa infection in both children and adults with cystic fibrosis (CF). Oral and intravenous ciprofloxacin have been shown to be well‐tolerated in the treatment of acute pulmonary exacerbations (APE) secondary to P. aeruginosa . Older literature supports an oral dosing regimen of 40 mg/kg/day divided every 12 hr, up to 2 g/day, and intravenous (IV) ciprofloxacin 30 mg/kg/day divided every 8 hr, maximum 1.2 g/day in children, and 750 mg administered orally twice a day or 400 mg IV every 8 hr in adults. However, a recent pharmacodynamic (PD) modeling study shows that the literature, U.S. Food and Drug Administration (FDA)‐approved, and Cystic Fibrosis Foundation (CFF) guideline dosing regimens may be suboptimal for the treatment of P. aeruginosa in APE. Further study is warranted to determine if higher doses of ciprofloxacin are needed. Limited pharmacokinetic (PK), PK/PD, and efficacy studies involving levofloxacin exist in adult patients with CF. No pediatric data exists for levofloxacin in CF patients. Further study is needed to determine the tolerability and efficacy of levofloxacin in APE. At this time, the routine use of levofloxacin in the treatment of APE in pediatric and adult patients cannot be recommended. Pediatr Pulmonol. 2013; 48:211–220. © 2012 Wiley Periodicals, Inc.