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Changing thresholds and incidence of antibiotic treatment of cystic fibrosis pulmonary exacerbations, 1995-2005

  • Researchers

    Vandevanter DR, Elkin EP, Pasta DJ, Morgan WJ, Konstan MW; Investigators and Coordinators of the Epidemiologic Study of Cystic Fibrosis.

  • Place of research

    Case Western Reserve University School of Medicine, Cleveland, Ohio,United States

  • Publication

    Journal of Cystic Fibrosis, July 2013

  • Subjects

    , ,

  • Have the number of pulmonary exacerbations in people with CF and the way physicians treat exacerbations with antibiotics changed in recent years?

  • Why is this important?

    Pulmonary exacerbations (sudden drop in lung function with more chest symptoms) are very serious, costly medical events that reduce quality of life and increase the risk of death in people with CF. Individuals with worse lung health are more likely to have exacerbations, but overall, the lung function of people with CF has steadily improved over time.

  • What did you do?

    We studied the number of pulmonary exacerbations treated with antibiotics among the Epidemiologic Study of CF (ESCF) Registry patients between 1995 and 2005 by age group and by whether intravenous (into the vein - IV) or oral and/or inhaled (non-IV) antibiotics were given. When available, patient signs and symptoms were studied to see if doctors changed how they decided who should receive antibiotics during the period.

  • What did you find?

    Antibiotic treatments for exacerbation fell steadily in patients 12 years of age and older, but only the number of IV treatments fell in younger children while non-IV treatments actually increased during the period. Progressively less sick patients of all ages (on average) were likely to be treated with non-IV antibiotics; less sick children under 6 years of age were also more likely to be treated with IV antibiotics.

  • What does this mean and reasons for caution?

    Our results suggest that improved lung health is reducing the need for IV antibiotic treatment of exacerbations, but non-IV treatments in all patients and IV treatments in young patients have become more common, at least in part because doctors have become more likely to treat less-sick patients.

  • What's next?

    We don’t know whether treating patients with milder symptoms of exacerbation produces better results. It will be important to follow successive groups of young children to measure whether these changes in practice have been beneficial.