Skip to main content
SpringerLink
Log in

Rational parameters for antibiotic therapy in patients with cystic fibrosis

Parameter für eine rationelle Antibiotikatherapie bei Patienten mit zystischer Fibrose

  • Originalia
  • Published:
Infection Aims and scope Submit manuscript

Summary

Data from the literature and the authors' experiences were used to review aspects of antibiotic therapy of patients with cystic fibrosis; attention was paid toin vitro antimicrobial susceptibility tests and assessment of therapy directed against mucoidPseudomonas aeruginosa. The heterogeneity ofP. aeruginosa within single sputa with respect to antibiotic susceptibility is stressed. Quantitative viable counts of bacteria based on an analysis of homogenised sputum is recommended. The mode ofin vivo growth of mucoidP. aeruginosa is discussed to explain the survival of hypersusceptibleP. aeruginosa in vivo, and the clinical benefit observed in the absence of a significant reduction of the pathogen. The value of ceftazidime in the treatment of exacerbations due toHaemophilus influenzae is emphasised. The social benefits from oral administration of ciprofloxacin also emphasises that the patient's quality of life must also be considered.

Zusammenfassung

In einer Übersicht werden Daten aus der Literatur und eigene Erfahrungen in der Antibiotikatherapie bei Patienten mit zystischer Fibrose dargestellt. DieIn vitro-Testung und klinische Beurteilung der Therapie von Infektionen durch mukoide Stämme vonPseudomonas aeruginosa finden besondere Beachtung.P. aeruginosa-Isolate aus einer einzigen Sputumprobe weisen im Hinblick auf ihre Antibiotikaempfindlichkeit eine bemerkenswerte Heterogenität auf. Keimzahlenbestimmungen sollten an homogenisierten Sputumproben vorgenommen werden. DasIn vivo-Wachstumsverhalten mukoiderP. aeruginosa-Stämme gibt Aufschluß über die Beobachtung, daß hochempfindliche Stämme vonP. aeruginosa in vivo überleben. Auf das Phänomen der klinischen Besserung ohne signifikante Erregerreduktion wird eingegangen. Hervorgehoben wird der Wert von Ceftazidim in der Therapie akuter Exazerbationen durchHaemophilus influenzae. Der soziale Gewinn einer oralen Therapie mit Ciprofloxacin weist auf die Bedeutung der Lebensqualität für den Patienten hin.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literature

  1. Lloyd-Still, J. D. In:Lloyd-Still, J. D. (ed.): Textbook of cystic fibrosis. John Wright, Boston 1983, p. 19.

    Google Scholar 

  2. Høiby, N. Microbiology of lung infections in cystic fibrosis patients. Acta Paediatr. Scand. (Suppl.) 301 (1982) 33–54.

    Google Scholar 

  3. Høiby, N. The management of pseudomonas chest infections — the way forward. In:Lawson, D. (ed. Cystic fibrosis: Horizons. Proceedings of the 9th International Cystic Fibrosis Congress, Brighton. John Wiley and Sons, Chichester 1985, pp. 87–95.

    Google Scholar 

  4. Irvin, R. T., Govan, J. R. W., Fyfe, J. A. M., Costerton, J. W. Heterogeneity of antibiotic resistance in mucoid isolates ofPseudomonas aeruginosa obtained from cystic fibrosis patients: role of outer membrane proteins. Antimicrob. Agents Chemother. 19 (1981) 1056–1063.

    Google Scholar 

  5. Pitt, T. L., MacDougal, J., Penketh, A. R. L., Cooke, E. M. Polyagglutinating and nontypable strains ofPseudomonas aeruginosa in cystic fibrosis. J. Med. Microbiol. 21 (1986) 179–186.

    Google Scholar 

  6. Seale, T. W., Thirkill, H., Tarpay, M. Flux, M., Rennert, O. M. Serotypes and antibiotic susceptibilities ofPseudomonas aeruginosa isolates from single sputa of cystic fibrosis patients. J. Clin. Microbiol. 9 (1979) 72–78.

    Google Scholar 

  7. Thomassen, M. J., Demko, C. A., Boxerbaum, B., Stern, R. C., Kuchenbrod, P. J. Multiple isolates ofPseudomonas aeruginosa with differing antimicrobial susceptibility patterns from patients with cystic fibrosis. J. Infect. Dis. 140 (1979) 873–880.

    Google Scholar 

  8. Bryan, L. E., Rabin, M. R. Studies on antibiotic susceptibility testing for therapy ofPseudomonas aeruginosa in cystic fibrosis. In:Sturgess, J. M. (ed.): Perspectives in cystic fibrosis. Proceedings of the 8th International Cystic Fibrosis Congress, Toronto. The Imperial Press Ltd., Mississauga 1980, p. 6a.

    Google Scholar 

  9. Fyfe, J. A. M., Govan, J. R. W. Synthesis, regulation and biological function of bacterial alginate. In:Bushell, M. E. (ed.): Progress in industrial microbiology. Vol. 18, Elsevier, Amsterdam 1983, pp. 46–83.

    Google Scholar 

  10. Fyfe, J. A. M., Govan, J. R. W. Chromosomal loci associated with antibiotic hypersensitivity in pulmonary isolates ofPseudomonas aeruginosa. J. Gen. Microbiol. 130 (1984) 825–834.

    Google Scholar 

  11. Govan, J. R. W., Fyfe, J. A. M. MucoidPseudomonas aeruginosa and cystic fibrosis: resistance of the mucoid form to carbenicillin, flucloxacillin and tobramycin and the isolation of mucoid variantsin vitro. J. Antimicrob. Chemother. 4 (1978) 233–240.

    Google Scholar 

  12. Govan, J. R. W., Fyfe, J. A. M., Jarman, T. R. Isolation of alginate-producing mutants ofPseudomonas fluorescens, Pseudomonas putida andPseudomonas mendocina. J. Gen. Microbiol. 125 (1981) 217–220.

    Google Scholar 

  13. Govan, J. R. W., Doherty, C., Raeburn, J. A., McCrae, W. M. In vitro activity of ciprofloxacin againstPseudomonas strains isolated from patients with cystic fibrosis and preliminary treatment results. Chemitherapia 4 (1985) 907–909.

    Google Scholar 

  14. Fyfe, J. A. M., Harris, G., Govan, J. R. W. Revised pyocin typing method forPseudomonas aeruginosa. J. Clin. Microbiol. 20 (1984) 47–50.

    Google Scholar 

  15. Govan, J. R. W., Doherty, C. Influence of antibiotics, alginate biosynthesis and hypersensitivity mutations onPseudomonas aeruginosa virulence factors associated with respiratory infections in patients with cystic fibrosis. In:Ishigami, J. (ed): Recent advances in chemotherapy. Proceedings of the 14th International Congress of Chemotherapy, Kyoto. University of Tokyo Press, Tokyo 1985, pp. 357–358.

    Google Scholar 

  16. Cullen, R. T., McCrae, W. M., Govan, J. R. W., Raeburn, J. A., Ingram, P. Ceftazidime in cystic fibrosis: clinical, microbiological and immunological studies. J. Antimicrob. Chemother. 12 suppl. A (1983) 369–375.

    Google Scholar 

  17. Govan, J. R. W., Fyfe, J. A. M., Baker, N. R. Heterogeneity and reduction in pulmonary clearance of mucoidPseudomonas aeruginosa. Rev. Infect. Dis. Suppl. 5 (1983) S874–879.

    Google Scholar 

  18. Lam, J., Chan, R., Lam, K., Costerton, J. W. Production of mucoid microcolonies byPseudomonas aeruginosa within infected lungs in cystic fibrosis. Infect. Immun. 28 (1980) 546–556.

    Google Scholar 

  19. Govan, J. R. W., Harris, G. Pseudomonas aeruginosa and cystic fibrosis: unusual bacterial adaptation and pathogenesis. Microbiol. Sci. 3 (1986) 302–308.

    Google Scholar 

  20. Evans, L. R., Linker, A. Production and characterization of the slime polysaccharide ofPseudomonas aeruginosa. J. Bacteriol. 116 (1973) 915–924.

    Google Scholar 

  21. Marcus, H., Baker, N. R. Quantitation of adherence of mucoid and nonmucoidPseudomonas aeruginosa to hamster tracheal epithelium. Infect. Immun. 47 (1985) 723–729.

    Google Scholar 

  22. Ramphal, R., Pier, G. B. Role ofPseudomonas aeruginosa mucoid exopolysaccharide in adherence to tracheal cells. Infect. Immun. 47 (1985) 1–4.

    Google Scholar 

  23. Bryan, L. E., Kureishi, A. Rabin, H. R. Detection of antibodies toPseudomonas aeruginosa alginate extracellular polysaccharide in animals and cystic fibrosis patients by ELISA. J. Clin. Microbiol. 18 (1983) 276–282.

    Google Scholar 

  24. Pier, G. Pulmonary disease associated withPseudomonas aeruginosa in cystic fibrosis: current status of the host-bacterium interaction. J. Infect. Dis. 4 (1985) 575–580.

    Google Scholar 

  25. Schøtz, P. O., Høiby, N., Nielsen, N., Glikmann, G., Svenag, S. E. Immune complexes in the sputum of patients with cystic fibrosis suffering from chronicPseudomonas aeruginosa lung infection. Acta Pathol. Microbiol. Scand. 86 (1978) 37–43.

    Google Scholar 

  26. Auerbach, H. S., Williams, M., Kirkpatrick, J. A., Colten, H. R. Alternate-day prednisolone reduces morbidity and improves pulmonary function in cystic fibrosis. Lancet II (1985) 686–688.

    Google Scholar 

  27. Baker, N. R. Role of exotoxin A and proteases ofPseudomonas aeruginosa in respiratory tract infections. Can. J. Microbiol. 28 (1982) 248–255.

    Google Scholar 

  28. Kulczycki, L. H., Murphy, T. M., Bellanti, J. A. Pseudomonas colonization in cystic fibrosis. A study of 160 patients. J. Am. Med. Assoc. 240 (1978) 30–34.

    Google Scholar 

  29. Cash, H. A., Woods, D. E., McCullough, B., Johanson, W. G., Bass, J. A. A rat model of chronic respiratory infection withPseudomonas aeruginosa. Am. Rev. Respir. Dis. 119 (1979) 453–459.

    Google Scholar 

  30. Mearns, M. B.: Natural history of pulmonary infection in cystic fibrosis. In:Sturgess, J. (ed.): Perspectives in cystic fibrosis. Proceedings of the 8th International Cystic Fibrosis Congress, Toronto. Canadian Cystic Fibrosis Foundation (1980) pp. 325–334.

  31. Batten, J. C. In:Flenley, D. C., Petty, T. L. (eds.): Recent advances in respiratory medicine. Churchill Livingstone, Edinburgh 1983, p. 115.

    Google Scholar 

  32. Editorial: Lancet II (1983) 257–258.

  33. Diaz, F., Mosovich, L. L., Neter, E. Serogroups ofPseudomonas aeruginosa and the immune response of patients with cystic fibrosis. J. Infect. Dis. 121 (1970) 269–274.

    Google Scholar 

  34. GAP Conference Report: Chronic bronchitis and cystic fibrosis. Cystic Fibrosis Foundation, Atlanta (1977).

  35. Phelan, P. D., Allan, J. L., Landau, L. I., Barnes, G. L. Improved survival of patients with cystic fibrosis. Med. J. Aust. I (1979) 261–263.

    Google Scholar 

  36. Leoning-Baucke, V. A., Mischler, E., Myers, M. G. A placebo controlled trial of cephalexin therapy in the ambulatory management of patients with cystic fibrosis. J. Pediatr. 95 (1979) 630–637.

    Google Scholar 

  37. Myers, M. G., Koontz, F. P., Weinberger, M. Lower respiratory tract infections in patients with cystic fibrosis. In:Lloyd-Still, J. D. (ed.): Textbook of cystic fibrosis. John Wright Inc., Boston 1983, pp. 91–107.

    Google Scholar 

  38. Szaff, M., Høiby, N., Flensborg, E. W. Frequent antibiotic therapy improves survival of cystic fibrosis patients with chronicPseudomonas aeruginosa infection. Acta Paediatr. Scand. 72 (1983) 651–657.

    Google Scholar 

  39. Littlewood, J. M., Miller, M. G., Ghoneum, A. T., Ramsden, C. H. Nebulised colomycin for early pseudomonas colonisation in cystic fibrosis. Lancet I (1985) p. 865.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Bacteriology, Medical School, University of Edinburgh, EH8 9AG, Edinburgh, Scotland

    J. R. W. Govan Ph. D. & Catherine Doherty F.I.L.M.S.

  2. Royal Hospital for Sick Children, Sciennes Road, EH9 1LF, Edinburgh, Scotland

    Sharon Glass MB. Ch. B., M.R.C.P.

Authors
  1. J. R. W. Govan Ph. D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine Doherty F.I.L.M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sharon Glass MB. Ch. B., M.R.C.P.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Govan, J.R.W., Doherty, C. & Glass, S. Rational parameters for antibiotic therapy in patients with cystic fibrosis. Infection 15, 300–307 (1987). https://doi.org/10.1007/BF01644142

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01644142

Keywords

Search

Navigation