Project Details

Inhaled antibiotic use for inpatient pediatric Cystic Fibrosis pulmonary exacerbations

Jonathan Cogen, MD, MPH

Summary

Rationale: Considerable morbidity and disease progression in people with cystic fibrosis (CF) result from pulmonary exacerbations (PEx). PEx guidelines note insufficient evidence to recommend for or against the concomitant use of inhaled and IV antibiotics. Objectives: We hypothesize that the addition of inhaled antibiotics for PEx therapy is associated with improvements in lung function and a longer time to next PEx compared with standard IV antibiotics alone. Methods: Retrospective cohort study using the CF Foundation Patient Registry-Pediatric Health Information System linked dataset. People with CF were included if hospitalized for PEx from 2006-2016 and 6-21 years of age. Lung function outcomes were assessed by linear mixed effect modeling and generalized estimating equations. Time to next PEx was assessed by Cox proportional hazards regression. To estimate independent causal effects while accounting for indication bias and other confounders, inverse probabilities of treatment weights were calculated based on covariates thought to influence the likelihood of inhaled antibiotic use during PEx treatment. Results: 3,253 children and adolescents contributed 9,040 PEx events for analysis. Inhaled antibiotics were used in 23% of PEx events but were not associated with better pre- to post-PEx ppFEV1 responses (mean difference –1.11%, [95% CI –1.83, –0.38]; p=0.003), higher odds of returning to lung function baseline (odds ratio 0.94, [0.82, 1.07]; p=0.34), or longer time to next PEx (hazard ratio 1.05, [0.99, 1.12]; p=0.098). Conclusions: The addition of inhaled antibiotics to standard IV antibiotic PEx treatment was not associated with improved lung function outcomes or a longer time to next PEx.

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