Inhaled antibiotic use for inpatient pediatric Cystic Fibrosis pulmonary exacerbations
Jonathan Cogen, MD, MPH
BACKGROUND: Pulmonary exacerbations are important contributors to the progression of cystic fibrosis (CF) lung disease and are associated with significant morbidity and mortality in children with this disease.
GAP: While guidelines from the CF Foundation on pulmonary exacerbation management exist, most of the statements are consensus-driven rather than evidence-based. In particular, evidence is lacking on the concomitant use of inhaled and IV antibiotics for pulmonary exacerbation treatment, as the aforementioned guidelines conclude insufficient evidence exists to recommend for or against this practice.
HYPOTHESIS: We hypothesize that the addition of inhaled antipseudomonal antibiotics to standard IV antipseudomonal therapy for the treatment of CF-related pulmonary exacerbations is associated with improved lung outcomes compared to patients receiving standard IV antipseudomonal therapy alone.
METHODS: This study will be a retrospective, propensity-score matched, case-control cohort study using a linked dataset created from the US CF National Patient Registry and Pediatric Health Information System (PHIS) database.
IMPACT: In the current era of increasing antimicrobial resistance secondary to antibiotic over-utilization, studies evaluating the role of antibiotics in clinical practice are paramount, and we hope results from this study can better inform CF healthcare providers in creating antibiotic treatment strategies for inpatient pulmonary exacerbation management. Our findings in CF may also inform studies of antibiotic treatment strategies for exacerbations of non-CF bronchiectasis and chronic bronchitis, thus providing a broader impact for children and adolescents with chronic respiratory conditions frequently requiring antibiotics.