For acute respiratory infection with cystic fibrosis:
Mild exacerbations generally respond to oral antibiotic therapy with or without inhaled antibiotics (tobramycin or aztreonam). The typical duration of antibiotic therapy is 14 days.
Primary options include:
amoxicillin/clavulanate,
trimethoprim/sulfamethoxazole,
linezolid, or
ciprofloxacin
.
Moderate and severe exacerbations are usually treated with intravenous antibiotics. The typical duration of antibiotic therapy is 14 days.
An aminoglycoside such as gentamicin is usually combined with one or two antibiotics that have Staphylococcus or Pseudomonas coverage, depending on suspected or known colonisation and the exacerbation severity. If no improvement is observed, a different antibiotic is usually tried.
One systematic review found little evidence that antimicrobial susceptibility testing predicts clinical response to treatment. However, treatment typically varies with the infection. For example, S aureus is treated with oxacillin, while linezolid and vancomycin are generally reserved for methicillin-resistant S aureus. P aeruginosa and Burkholderia cepacia can both be treated with ceftazidime or piperacillin/tazobactam, but the most effective strategy is unclear.
In severe infection with resistant strains, aztreonam, imipenem/cilastatin, or meropenem can be used.
Drug levels should be monitored appropriately. Disease-specific changes can accelerate aminoglycoside clearance and may necessitate higher doses to reach therapeutic levels. Be vigilant for adverse drug reactions.
Primary options include:
ceftazidime,
piperacillin/tazobactam,
aztreonam,
imipenem/cilastatin,
meropenem,
linezolid, or
vancomycin
