Open AccessOral antimicrobial use in outpatient cystic fibrosis pulmonary exacerbation management: a single‐center experience
Author(s) -
Briggs Elissa Charlotte,
Nguyen Thuan,
Wall Michael Abraham,
MacDonald Kelvin David
Publication year - 2012
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/j.1752-699x.2011.00246.x
Subject(s) - medicine , exacerbation , cystic fibrosis , odds ratio , allergic bronchopulmonary aspergillosis , body mass index , antibiotics , gastroenterology , immunology , microbiology and biotechnology , biology , immunoglobulin e , antibody
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 1 s (FEV 1 ) <75% of predicted prior to an acute exacerbation (OR 1.93, CI 1.20–3.08). Decline in FEV 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. Please cite this paper as: Briggs EC, Nguyen T, Wall MC and MacDonald KD. Oral antimicrobial use in outpatient cystic fibrosis pulmonary exacerbation management: a single‐center experience. Clin Respir J 2012; 6: 56–64.