Oral antibiotics for treating infection with <I>Pseudomonas aeruginosa </I>in people with cystic fibrosis

Remmington T, Jahnke N, Harkensee C

Published Online:

November 10, 2010

Treatment of Pseudomonas aeruginosa (P. aeruginosa) lung infection is of great importance in managing cystic fibrosis lung disease. Oral anti-pseudomonal antibiotics which are as effective and safe as intravenous or nebulised antibiotics would improve the quality of life of people with CF due to ease of drug administration and the avoidance of hospitalisation.

We found no conclusive evidence showing an oral antibiotic regimen to be more or less effective than an alternative treatment for either pulmonary exacerbations or long-term treatment of chronic infection with P. aeruginosa. However, the evidence available was limited as there were only five trials with 256 participants. Also the trials were very different in terms of design, drugs used, duration of treatment and follow up and outcome measures. Until results of adequately-powered future trials are available, treatment needs to be selected on a pragmatic basis, based upon any available non-RCT evidence, the clinical circumstances of the individual, the known effectiveness of drugs against local strains and upon individual preference.

Abstract (click to read)

Background:

Pseudomonas aeruginosa is the most common bacterial pathogen causing lung infections in people with CF and appropriate antibiotic therapy is vital. Antibiotics for pulmonary exacerbations are usually given intravenously, and for long-term treatment, via a nebuliser. Oral anti-pseudomonal antibiotics with the same efficacy and safety as intravenous or nebulised antibiotics would benefit people with CF due to ease of treatment and avoidance of hospitalisation.

Objectives:

To determine the benefit or harm of oral anti-pseudomonal antibiotic therapy for people with CF, colonised with Pseudomonas aeruginosa, in the:
1. treatment of a pulmonary exacerbation; and
2. long-term treatment of chronic infection.

Search strategy:

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.

We contacted pharmaceutical companies and checked reference lists of identified trials.

Last search: 22 April 2010.

Selection criteria:

Randomised or quasi-randomised controlled trials comparing any dose of oral anti-pseudomonal antibiotics, to other combinations of inhaled, oral or intravenous antibiotics, or to placebo or usual treatment for pulmonary exacerbations and long-term treatment.

Data collection and analysis:

Two authors independently selected the trials, extracted data and assessed quality. We contacted trialists to obtain missing information.

Main results:

We included three trials examining pulmonary exacerbations (171 participants) and two trials examining long-term therapy (85 participants). We regarded the most important outcomes as quality of life and lung function. The analysis did not identify any statistically significant difference between oral anti-pseudomonal antibiotics and other treatments for these outcome measures for either pulmonary exacerbations or long-term treatment. One of the included trials reported significantly better lung function when treating a pulmonary exacerbation with ciprofloxacin when compared with intravenous treatment; however, our analysis did not confirm this finding. We found no evidence of difference between oral anti-pseudomonal antibiotics and other treatments regarding adverse events or development of antibiotic resistance, but trials were not adequately powered to detect this.

Authors' conclusions:

We found no conclusive evidence that an oral anti-pseudomonal antibiotic regimen is more or less effective than an alternative treatment for either pulmonary exacerbations or long-term treatment of chronic infection with P. aeruginosa. Until results of adequately-powered future trials are available, treatment needs to be selected on a pragmatic basis, based upon any available non-RCT evidence, the clinical circumstances of the individual, the known effectiveness of drugs against local strains and upon individual preference.

This record should be cited as:

Remmington T, Jahnke N, Harkensee C. Oral anti-pseudomonal antibiotics for cystic fibrosis. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005405. DOI: 10.1002/14651858.CD005405.pub2

Assessed as up to date:

October 6, 2010

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Primary Review Group:

Cystic Fibrosis and Genetic Disorders Group

Health topics:

Genetic disorders > Cystic fibrosis > Antibiotic treatment

Lungs & airways > Cystic fibrosis > Antibiotic treatment

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Independent high-quality evidence for health care decision making

Oral antibiotics for treating infection with <I>Pseudomonas aeruginosa </I>in people with cystic fibrosis

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