Introduction and Objectives Antibiotic adverse reactions present a challenge when choosing appropriate treatment for patients with Bronchiectasis. We explored our data for antibiotic allergy and microbiological resistance in Bronchiectasis patients in a specialist clinic at the Queen Elizabeth Hospital Birmingham.
Methods We collected retrospective and prospective data on 243 patients from our Bronchiectasis clinic. We limited our microbiological data to colonised or most recent sputum culture.
Results We have 243 patients on our register. There were 84 (34.6%) males and 159 (65.6%) females. Bronchiectasis was confirmed in 234 patients with CT (Computerised Tomography) scan. The most common aetiology was post-infective.
80 (32.9%) patients had had an adverse drug reaction to at least one antibiotic. 24(9.8%) were allergic to penicillin and 50(20.5%) were allergic to at least one antibiotic. 29 (11.9%) were intolerant of one or more oral antibiotics whereas 18 (7.4%) were intolerant of one or more nebulized antibiotics in this group.
Patients with resistant bacteria in their sputum showed a trend towards a greater likelihood of adverse reactions to antibiotics compared to patients with sensitive bacteria (31.5% v 17.8% p Value - 0.05). On subgroup analysis we found that the difference became statistically significant between people infected with resistant versus sensitive Pseudomonas Aeruginosa (46.7% v 42.1% p value–0.031).
Conclusions This is an interesting observation that patients whose sputum contained resistant organisms were more likely to have had adverse drug reactions to antibiotics. There is likely to be a causal relationship, and further study is required to identify whether the limited range of treatment options for patients with adverse drug reactions leads to a greater chance of antibiotic resistance in colonising organisms in sputum. Antibiotic allergies may have a detrimental effect on the management of patients with Bronchiectasis and therefore a resource implication in the subgroup of patients with adverse drug reactions. Potentially there may be a cost-saving in investigating patient-reported allergies aggressively.
Antimicrobial therapy for bronchiectasis. O'Donnell AE. Clin Chest Med. 2012 Jun;33(2):381–6. doi: 10.1016/j.ccm.2012.03.005. Epub 2012 Apr 24
Clinical challenges in managing bronchiectasis. Tsang KW, Bilton D. Respirology. 2009 Jul;14(5):637–50. doi: 10.1111/j.1440–1843.2009.01569.x
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