Dataset Information

Characteristics and outcomes of oral antibiotic treated pulmonary exacerbations in children with cystic fibrosis.

ABSTRACT:

Background

Pulmonary exacerbations (PEx) in children with cystic fibrosis (CF) are frequently treated in the outpatient setting with oral antibiotics. However, little is known about the characteristics of PEx managed on an outpatient basis and the effectiveness of oral antibiotic therapy. We sought to prospectively evaluate clinical and laboratory changes associated with oral antibiotic treatment for PEx.

Methods

Children with CF between 8 and 18?years of age prescribed two weeks of oral antibiotics for a PEx were eligible to enroll. The study consisted of a visit within 48?h of starting antibiotics and a second visit within one week of antibiotic completion. Twenty-eight participants were evaluated by exacerbation score, quality of life measurements, lung function, sputum microbiology and inflammation.

Results

Oral antibiotic treatment was associated with a significant improvement in exacerbation score and quality of life measured by the CF Questionnaire-Revised (CFQ-R) respiratory domain. Following treatment, forced expiratory volume in 1?s (FEV₁) % predicted increased [median (range)] 9% (-8%, 31%), and 22 (81%) subjects returned to 90% or higher of baseline FEV₁. Bacterial density of the primary organism identified on sputum culture decreased significantly with a median (range) decrease of 0.8 log₁₀ cfu/mL (-8 log₁₀, 2 log_10, p?=?0.03). Sputum neutrophil elastase [-37??g/mL (-464, 272), p?=?0.02] and IL-1? [-2.8?×?10³?g/mL (-6.9?×?10⁴, 3.3?×?10⁴), p?=?0.03] decreased significantly following treatment in this cohort.

Conclusions

Treatment of PEx with oral antibiotics was associated with measurable improvements in patient reported outcomes, lung function, bacterial density and sputum inflammatory markers.

SUBMITTER: Hoppe JE

PROVIDER: S-EPMC7105204 | biostudies-literature | 2018 Nov

REPOSITORIES: biostudies-literature

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Publications

Characteristics and outcomes of oral antibiotic treated pulmonary exacerbations in children with cystic fibrosis.

Hoppe Jordana E JE Wagner Brandie D BD Accurso Frank J FJ Zemanick Edith T ET Sagel Scott D SD

Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society 20180618 6

<h4>Background</h4>Pulmonary exacerbations (PEx) in children with cystic fibrosis (CF) are frequently treated in the outpatient setting with oral antibiotics. However, little is known about the characteristics of PEx managed on an outpatient basis and the effectiveness of oral antibiotic therapy. We sought to prospectively evaluate clinical and laboratory changes associated with oral antibiotic treatment for PEx.<h4>Methods</h4>Children with CF between 8 and 18 years of age prescribed two weeks ...[more]

PMID: 29921503

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Project description:Pulmonary exacerbations lead to significant morbidity and mortality in patients with cystic fibrosis (CF). National consensus guidelines exist, but few studies report current practice in the treatment and monitoring of pulmonary exacerbations. The goal of this study was to characterize consistency and variability in the inpatient management of CF-related pulmonary exacerbations. We focused on the use of guideline-recommended maintenance therapies, antibiotic selection and treatment regimens, use of systemic corticosteroids, and frequency of lung function testing. We hypothesized that significant variability in these treatment practices exists nationally. This trial was a retrospective cross-sectional study. It included patients with CF aged ≤18 years hospitalized for pulmonary exacerbations between July 1, 2010, and June 30, 2015, at hospitals within the US Pediatric Health Information System database that are also Cystic Fibrosis Foundation-accredited care centers. One exacerbation per patient was randomly selected over the 5-year study period. From 38 hospitals, 4827 individual pulmonary exacerbations were examined. Median length of stay was 10.0 days (interquartile range, 6-14.0 days). Significant variation was seen among centers in the use of hypertonic saline (11%-100%), azithromycin (5%-83%), and systemic corticosteroids (3%-61%) and in the frequency of lung function testing. Four different admission antibiotic regimens were used >10% of the time, and the most commonly used admission antibiotic regimen comprised 2 intravenous antibiotics with no additional oral or inhaled antibiotics (29%). Significant variation exists in the treatment and monitoring of pulmonary exacerbations across Pediatric Health Information System-participating, Cystic Fibrosis Foundation-accredited care centers. Results from this study can inform future research working toward standardized inpatient pulmonary exacerbation management to improve CF care for children and adolescents.

Dataset Information

Characteristics and outcomes of oral antibiotic treated pulmonary exacerbations in children with cystic fibrosis.

Background

Methods

Results

Conclusions

Publications

Characteristics and outcomes of oral antibiotic treated pulmonary exacerbations in children with cystic fibrosis.

Similar Datasets

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