Antimicrobial therapy for pulmonary pathogenic colonisation and infection by Pseudomonas aeruginosa in cystic fibrosis patients

被引:107
作者
Cantón, R
Cobos, N
de Gracia, J
Baquero, F
Honorato, J
Gartner, S
Alvarez, A
Salcedo, A
Oliver, A
García-Quetglas, E
机构
[1] Hosp Univ Ramon y Cajal, Microbiol Serv, Madrid 28034, Spain
[2] Hosp Valle De Hebron, Unidad Fibrosis Quist, Barcelona, Spain
[3] Clin Univ, Serv Farmacol Clin, Pamplona, Spain
[4] Hosp Materno Infantil Univ Gregorio Maranon, Secc Neumol Pediat, Madrid, Spain
[5] Hosp Son Dureta, Microbiol Serv, Palma de Mallorca, Spain
关键词
colonisation; cystic fibrosis; Pseudomonas aeruginosa; pulmonary colonisation; review; therapy;
D O I
10.1111/j.1469-0691.2005.01217.x
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Pseudomonas aeruginosa colonisation has a negative effect on pulmonary function in cystic fibrosis patients. The organism can only be eradicated in the early stage of colonisation, while reduction of bacterial density is desirable during chronic colonisation or exacerbations. Monthly, or at least 3-monthly, microbiological culture is advisable for patients without previous evidence of P. aeruginosa colonisation. Cultures should be performed at least every 2-3 months in patients with well-established colonisation, and always during exacerbations or hospitalisations. Treatment of patients following the first isolation of P. aeruginosa, but with no clinical signs of colonisation, should be with oral ciprofloxacin (15-20 mg/kg twice-daily for 3-4 weeks) plus inhaled tobramycin or colistin (intravenous treatment with or without inhaled treatment can be used as an alternative), while patients with acute infection should be treated for 14-21 days with high doses of two intravenous antimicrobial agents, with or without an inhaled treatment during or at the end of the intravenous treatment. Maintenance treatment after development of chronic P. aeruginosa infection/colonisation (pathogenic colonisation) in stable patients (aged > 6 years) should be with inhaled tobramycin (300 mg twice-daily) in 28-day cycles (on-off) or, as an alternative, colistin (1-3 million units twice-daily). Colistin is also a possible choice for patients aged < 6 years. Treatment can be completed with oral ciprofloxacin (3-4 weeks every 3-4 months) for patients with mild pulmonary symptoms, or intravenously (every 3-4 months) for those with severe symptoms or isolates with ciprofloxacin resistance. Moderate and serious exacerbations can be treated with intravenous ceftazidime (50-70 mg/kg three-times-daily) or cefepime (50 mg/kg three-times-daily) plus tobramycin (5-10 mg/kg every 24 h) or amikacin (20-30 mg/kg every 24 h) for 2-3 weeks. Oral ciprofloxacin is recommended for patients with mild pulmonary disease. If multiresistant P. aeruginosa is isolated, antimicrobial agents that retain activity are recommended and epidemiological control measures should be established.
引用
收藏
页码:690 / 703
页数:14
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