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The effect of antibiotic changes during treatment of cystic fibrosis pulmonary exacerbations

  • Andrew Zikic
    Affiliations
    Division of Paediatric Medicine, Department Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario M5G 1X8, Canada
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  • Felix Ratjen
    Affiliations
    Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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  • Michelle Shaw
    Affiliations
    Division of Respiratory Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
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  • Elizabeth Tullis
    Affiliations
    Division of Respirology, Department of Medicine St Michael's Hospital, University of Toronto, Toronto, Canada
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  • Valerie Waters
    Correspondence
    Corresponding author at: Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
    Affiliations
    Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada

    Translational Medicine Program, Hospital for Sick Children, University of Toronto, Toronto, Canada
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      Highlights

      • CF providers often change antibiotics during pulmonary exacerbations.
      • Reasons for change vary but often include poor treatment response.
      • Changing antibiotics in poor responders does not affect lung function recovery.

      Abstract

      Background

      Antibiotics are often changed during treatment of pulmonary exacerbations (PEx) in people with cystic fibrosis (CF) who have a poor clinical response. We aimed to characterize the reasons CF providers change antibiotics and examined the effects of antibiotic changes on lung function recovery.

      Methods

      This was a retrospective cohort study using the Toronto CF Database from 2009 to 2015 of adults and children with CF PEx treated with intravenous antibiotics. The co-primary outcome measure was absolute and relative change in forced expiratory lung volume in 1 s (FEV1) at end of treatment and follow-up. Secondary outcome assessed the proportion of patients returning to > 90% or > 100% previous baseline FEV1.

      Results

      A total of 399 PEx were included of which 105 had antibiotic changes. Reasons for antibiotic changes included change in antibiotic route prior to discharge (26%), drug reactions (20%), poor FEV1 response (25%), targeting additional microbes (16%) and lack of symptom improvement (13%). In our multivariable analysis, among non-responders (< 90% FEV1 recovery to baseline or lack of symptom improvement at the interim time point), a change in antibiotics was not associated with any significant difference in absolute or relative FEV1 at end of treatment or at follow-up. Antibiotic change in non-responders was not associated with improved return to 90% or 100% baseline FEV1 at end of treatment or follow-up.

      Conclusions

      Changing antibiotics during CF PEx treatment in those with poor clinical response was not associated with any improved FEV1 response or return to baseline lung function.
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