Systematic review of antistaphylococcal antibiotic therapy in cystic fibrosis
a Department
of Child Health, b Medical Library, c University of Dundee, Ninewells Hospital and
Medical School, Dundee DD1 9SY, UK
Correspondence to: Dr S Mukhopadhyay.
Received 28 September 1998; Returned to authors 28 October 1998; Revised version received 9 November 1998; Accepted for publication 11 November 1998
BACKGROUND
The
respiratory tract in patients with cystic fibrosis is frequently
colonised with Staphylococcus aureus. There
is great diversity of clinical practice in this area of cystic
fibrosis. A systematic review was conducted to study the evidence
relating antistaphylococcal therapy to clinical outcome in patients
with cystic fibrosis.
METHODSA search
strategy already evaluated for the study of the epidemiology of cystic
fibrosis clinical trials was used. This yielded 3188 references from
which 13 clinical trials of antistaphylococcal therapy were identified.
RESULTSSubstantial
heterogeneity was observed between trials. In the 13 clinical trials a
total of 19 antibiotics were used to assess a wide variety of outcome
measures (11 clinical, six laboratory). Both intermittent and
continuous treatment strategies were used. Sputum clearance of
S aureus was more frequently achieved than any other beneficial outcome. A beneficial effect on pulmonary function
was rarely measured or observed. Although five randomised clinical
trials were identified, the extent of heterogeneity precluded the use
of meta-analysis for further synthesis of information.
CONCLUSIONSAntistaphylococcal
treatment achieves sputum clearance of S
aureus in patients with cystic fibrosis. Prophylactic
antistaphylococcal treatment in young children with cystic fibrosis is
likely to be of clinical benefit. It remains to be determined whether
the use of "prophylactic" versus "intermittent"
antistaphylococcal therapy in cystic fibrosis is associated with
improved lung function and/or chest radiographic scores, an increase in
bacterial resistance, or earlier acquisition of
Pseudomonas aeruginosa. A large randomised clinical trial lasting approximately two years is urgently required to
address this problem.
Keywords: cystic fibrosis; Staphylococcus aureus; systematic review
* Current address: Department of Child Health, University of Glasgow, Royal Hospital for Sick Children, Glasgow, UK.
© 1999 by Thorax
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