CF Flashcards
clinical presentation
increased cough
increased sputum production
SOB
chest pain
loss of appetite
weight loss
decreased FEV1
decreased FVC
Common pathogens of CF
pseudomonas aeruginosa**
strenotrophomonas maltophilia
MRSA**
acchomocter xylosoxidans
burkhoderia cepacia complex**
nontuberculosis mycobacteria
initial antimicrobial selection
typical pathogens for age
recent culture data
recent outpatient antiimicribial use
previous abx that result in clinical improvement
allergies
advere effects
mucoid
slimy or viscous consistency of bacterial colony
caused by the adaptation that assist the bacteria with resisting antibiotic
seen w persistent pseudomonas infections
aggressive therapy in CF
antibiotic selection for pulmonary exacerbation
no clear consensus what should be prescribed
target most common organism in respiratory tract
quarterly sputum collection for empiric therapy
pulmonary exacerbations =
respiratory symptoms + decline in lung function
two antibiotics
decreased resistance
higher cost
toxicity risk
one antibiotic
increased resistance
reduced cost
reduced toxicity
most centers us a two antibiotic regimen for CF exacerbations to target what
Pseudomonas
what is the outcome of using two different mechanism of action
synergistic activity in vitro
ex: AMG+ beta lactam
when is acute inpatient management indicated
severe exacerbations
resistance to oral antibiotics
failure to resolve exacerbations
antibiotic selection for acute inpatient is based on
sensitivities
microbial culture
renal function
previous clinical response
routes for acute pulmonary exacerbations
oral
IV
aerosolized
first treatment options for Pseudomonas
- tobramycin, amikacin
-cirprofloxacin
second treatment options for Pseudomonas
-piperacillin/tazobactam
-ceftazidime, cefepime
-carbapenem, meropenem, imipenem
treatment option for stenotrophonas maltophilia
-sulfamethoxazole/trimethoprim
-levofloxacin
-ceftazidime
-piperacillin/tazobactam
treatment option for MRSA
vancomycin ***
linezolid **
sulfamethoxazole/trimethoprim
ceftaroline
clindamycin
if MSSA treatment
may use beta lactase except ceftazidime (poor coverage)
treatment option for stenotrophomonas maltopilia
-sulfamethoxazole/trimethoprim
-levofloxacin
-ceftazidime
-piperacillin/tazobactam
treatment option for burkholderia cepacia complex
-sulfamethoxazole/trimethoprim
-doxycycline
-ceftazidime
-meropenem
How long are CF drugs administered and what are the drugs commonly used for pseudomonas
longer period of time
beta lactams
-cepfepime
-ceftazidime
-imipenem
-meropenem
-piperacillin/tazobactam
-
PK of CF
larger volume of distribution
faster clearance
larger antibiotic doses and shorter dosing intervals
therapeutic drug monitoring and necessary dosage and regimen adjustments are critical
dosing strategies of AMG
high doses, extended interval doses
monitoring: random only
less doses and TDM
lower is of toxicity
higher doses=higher peaks
extended intervals=lower troughs= lower troughs =lower toxicity
TOPIC study Conclusion
IV tobramycin had equal Efficacy given one vs three times a day for CF
once a day is less nephrotoxic
