Effect of pulmonary exacerbations treated with oral antibiotics on clinical outcomes in cystic fibrosis

被引:50
|
作者
Stanojevic, Sanja [1 ]
McDonald, Alexandra [1 ]
Waters, Valerie [2 ]
MacDonald, Sarah [1 ]
Horton, Eric [1 ]
Tullis, Elizabeth [3 ,4 ]
Ratjen, Felix [1 ]
机构
[1] Univ Toronto, Hosp Sick Children, Div Resp Med, Dept Pediat, Toronto, ON, Canada
[2] Univ Toronto, Hosp Sick Children, Div Infect Dis, Dept Pediat, Toronto, ON, Canada
[3] Li Ka Shing Knowledge Inst, Div Respirol, Keenan Res Ctr, Toronto, ON, Canada
[4] Univ Toronto, St Michaels Hosp, Dept Med, Toronto, ON, Canada
关键词
STENOTROPHOMONAS-MALTOPHILIA; TOBRAMYCIN; EFFICACY; DECLINE; ADULTS; TRIAL;
D O I
10.1136/thoraxjnl-2016-208450
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background Despite extensive knowledge regarding the effect of pulmonary exacerbations treated with intravenous antibiotics on clinical outcomes in cystic fibrosis (CF), there is little known about the role of milder pulmonary exacerbations treated with oral antibiotics (oPEx). Methods This was a retrospective cohort study of patients with CF followed at the Hospital for Sick Children and St. Michael's Hospital from 2009 to 2014. We evaluated the effect of oPEx on short-term clinical outcomes as the proportion of oPEx events in which 100% or 90% of baseline FEV1% predicted was recovered at the end of treatment. We then examined the association of the number of oPEx events in the past 12 months on lung function (FEV1% predicted) and nutritional status (body mass index (BMI) z-score) using a mixed-effects model. Results There were a total of 2608 oPEx events in 570 subjects during the study period. In over half (53.4%) of oPEx events, lung function was already at 90% or higher of baseline FEV1 at the initiation of oral antibiotic therapy and 82% were at 90% or higher of baseline FEV1 at follow-up. In individuals with CF, one or more oPex events in the previous 12 months were associated with decreased FEV1 compared with 12 months periods without oPex events. When the cumulative effect of oPExs on lung function was examined over the entire study period, patients with six or more oPEx events had the steepest rate of FEV1 decline. oPEx events were not associated with changes in BMI. Conclusions oPEx events are associated with short-term loss of FEV1 and have a negative effect on lung function over time.
引用
收藏
页码:327 / 332
页数:6
相关论文
共 50 条
  • [31] Pulmonary exacerbations in cystic fibrosis and bronchiectasis
    Elborn, J. S.
    Bell, S. C.
    THORAX, 2007, 62 (04) : 288 - 290
  • [32] Treatment of pulmonary exacerbations in cystic fibrosis
    Ng, Christabella
    Nadig, Tejaswi
    Smyth, Alan R.
    Flume, Patrick
    CURRENT OPINION IN PULMONARY MEDICINE, 2020, 26 (06) : 679 - 684
  • [33] Effect of esomeprazole versus placebo on pulmonary exacerbations in cystic fibrosis
    DiMango, Emily
    Walker, Patricia
    Keating, Claire
    Berdella, Maria
    Robinson, Newell
    Langfelder-Schwind, Elinor
    Levy, Diane
    Liu, Xinhua
    BMC PULMONARY MEDICINE, 2014, 14
  • [34] Effect of Treatment of Cystic Fibrosis Pulmonary Exacerbations on Systemic Inflammation
    Sagel, Scott D.
    Thompson, Valeria
    Chmiel, James F.
    Montgomery, Gregory S.
    Nasr, Samya Z.
    Perkett, Elizabeth
    Saavedra, Milene T.
    Slovis, Bonnie
    Anthony, Margaret M.
    Emmett, Peggy
    Heltshe, Sonya L.
    ANNALS OF THE AMERICAN THORACIC SOCIETY, 2015, 12 (05) : 708 - 717
  • [35] Effect of esomeprazole versus placebo on pulmonary exacerbations in cystic fibrosis
    Emily DiMango
    Patricia Walker
    Claire Keating
    Maria Berdella
    Newell Robinson
    Elinor Langfelder-Schwind
    Diane Levy
    Xinhua Liu
    BMC Pulmonary Medicine, 14
  • [36] PROSPECTIVE EVALUATION OF THE OUTCOMES FOLLOWING TREATMENT OF PULMONARY EXACERBATIONS WITH ORAL ANTIBIOTICS
    Orchard, C.
    Simmonds, N.
    Baker, E.
    Bush, A.
    Bilton, D.
    PEDIATRIC PULMONOLOGY, 2013, 48 : 347 - 348
  • [37] Glucocorticoids as an adjuvant treatment to intravenous antibiotics for cystic fibrosis pulmonary exacerbations: A UK survey
    Hester, K. L. M.
    Powell, T.
    Downey, D. G.
    Elborn, J. S.
    Jarad, N. A.
    JOURNAL OF CYSTIC FIBROSIS, 2007, 6 (04) : 311 - 313
  • [38] Twice vs three times daily antibiotics in the treatment of pulmonary exacerbations of cystic fibrosis
    Smyth, Alan
    Knox, Alan
    JOURNAL OF CYSTIC FIBROSIS, 2011, 10 (05) : 383 - 383
  • [39] Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations
    Sequeiros, Iara Maria
    Jarad, Nabil A.
    CHRONIC RESPIRATORY DISEASE, 2012, 9 (04) : 213 - 220
  • [40] Glucocorticoids as an adjuvant treatment to intravenous antibiotics for cystic fibrosis pulmonary exacerbations: A UK survey
    Hester, K. L. M.
    Powell, T.
    Downey, D. G.
    Elborn, J. S.
    Jarad, N. A.
    THORAX, 2006, 61 : II120 - II121