TY - JOUR

T1 - Continuous vs Thrice-Daily Ceftazidime for Elective Intravenous Antipseudomonal Therapy in Cystic Fibrosis

AU - Riethmüller, J.

AU - Junge, S.

AU - Schröter, T. W.

AU - Kümmerer, Klaus

AU - Franke, P.

AU - Ballmann, M.

AU - Claass, A.

AU - Brömme, S.

AU - Jeschke, R.

AU - Hebestreit, A.

AU - Staab, D.

AU - Kötz, K.

AU - Döring, G.

AU - Stern, M.

PY - 2009/10

Y1 - 2009/10

N2 - Background/aim: : We hypothesized that a continuous 24-h infusion of 100 mg/kg per day ceftazidime (treatment C) would result in equivalent or even superior anti-infectious efficacy in chronic Pseudomonus aeruginosa (PA) infection in patients with cystic fibrosis (CF) in comparison to the usual application of 200 mg/kg per day ceftazidime in three doses (treatment T). Methods: : This was a randomized crossover study comparing outcome after 14 days and 35 days. Tobramycin administered once daily (10 mg/kg per day) was administered concomitantly in both groups. The primary end-point was a decrease in the leukocyte count, and the secondary endpoints were clinical and lung function parameters, Pseudomonas quantification in sputum, and inflammation markers (immunogloblulin [Ig] G, C-reactive protein [CRP]) in serum. All patients received antibiotics electively as 14-day courses on a regular basis, not for acute exacerbations. Results: : Fifty-six patients (29 females, mean patient age 14.4 years, age range 5-37) initially received treatments C or T, followed by the alternative treatment after amean interval of 37 (± 21) weeks. After 2 weeks of antibiotic treatment, the overall study group showed significant improvements compared to baseline for body weight, leukocyte counts, CRP, forced expiratory volume in 1 s (FEV 1), FVC (forced vital capacity), and bacterial load in the airways, with no significant differences between treatment groups. Both regimens were well tolerated. Threeweeks after cessation of antimicrobial therapy, leukocytes and PA density had returned to pre-treatment values. Conclusion: : We conclude that continuous or thrice-daily dosing of intravenous ceftazidime, both combined with once-daily tobramycin, are equally effective application regimens for elective antipseudomonal therapy in clinically stable patients with CF.

AB - Background/aim: : We hypothesized that a continuous 24-h infusion of 100 mg/kg per day ceftazidime (treatment C) would result in equivalent or even superior anti-infectious efficacy in chronic Pseudomonus aeruginosa (PA) infection in patients with cystic fibrosis (CF) in comparison to the usual application of 200 mg/kg per day ceftazidime in three doses (treatment T). Methods: : This was a randomized crossover study comparing outcome after 14 days and 35 days. Tobramycin administered once daily (10 mg/kg per day) was administered concomitantly in both groups. The primary end-point was a decrease in the leukocyte count, and the secondary endpoints were clinical and lung function parameters, Pseudomonas quantification in sputum, and inflammation markers (immunogloblulin [Ig] G, C-reactive protein [CRP]) in serum. All patients received antibiotics electively as 14-day courses on a regular basis, not for acute exacerbations. Results: : Fifty-six patients (29 females, mean patient age 14.4 years, age range 5-37) initially received treatments C or T, followed by the alternative treatment after amean interval of 37 (± 21) weeks. After 2 weeks of antibiotic treatment, the overall study group showed significant improvements compared to baseline for body weight, leukocyte counts, CRP, forced expiratory volume in 1 s (FEV 1), FVC (forced vital capacity), and bacterial load in the airways, with no significant differences between treatment groups. Both regimens were well tolerated. Threeweeks after cessation of antimicrobial therapy, leukocytes and PA density had returned to pre-treatment values. Conclusion: : We conclude that continuous or thrice-daily dosing of intravenous ceftazidime, both combined with once-daily tobramycin, are equally effective application regimens for elective antipseudomonal therapy in clinically stable patients with CF.

KW - Chemistry

KW - age

KW - ANTIBIOTIC

KW - Antibiotics

KW - antimicrobial

KW - BACTERIAL

KW - ceftazidime

KW - CYSTIC-FIBROSIS

KW - DENSITIES

KW - DENSITY

KW - DIFFERENCE

KW - Efficacy

KW - IMPROVEMENT

KW - INFECTION

KW - LUNG

KW - Marker

KW - Method

KW - Methods

KW - PARAMETER

KW - PARAMETERS

KW - PATIENT

KW - PRETREATMENT

KW - PROTEIN

KW - QUANTIFICATION

KW - Serum

KW - Sputum

KW - THERAPY

KW - treatment

KW - WELL

UR - http://www.scopus.com/inward/record.url?scp=70350159342&partnerID=8YFLogxK

UR - https://www.mendeley.com/catalogue/860cb9e6-dea1-3f9d-b64e-c737ae8c63d1/

U2 - 10.1007/s15010-009-8116-5

DO - 10.1007/s15010-009-8116-5

M3 - Journal articles

C2 - 19756419

VL - 37

SP - 418

EP - 423

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

SN - 1198-743X

IS - 5

ER -