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Arch Pediatr Adolesc Med. 2011 Sep;165(9):847-56. doi: 10.1001/archpediatrics.2011.136.

Comparative efficacy and safety of 4 randomized regimens to treat early Pseudomonas aeruginosa infection in children with cystic fibrosis.

Author information

1
Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, WA 98104, USA. treggmm@uw.edu

Abstract

OBJECTIVE:

To investigate the efficacy and safety of 4 antipseudomonal treatments in children with cystic fibrosis with recently acquired Pseudomonas aeruginosa infection.

DESIGN:

Randomized controlled trial.

SETTING:

Multicenter trial in the United States.

PARTICIPANTS:

Three hundred four children with cystic fibrosis aged 1 to 12 years within 6 months of P aeruginosa detection.

INTERVENTIONS:

Participants were randomized to 1 of 4 antibiotic regimens for 18 months (six 12-week quarters) between December 2004 and June 2009. Participants randomized to cycled therapy received tobramycin inhalation solution (300 mg twice a day) for 28 days, with oral ciprofloxacin (15-20 mg/kg twice a day) or oral placebo for 14 days every quarter, while participants randomized to culture-based therapy received the same treatments only during quarters with positive P aeruginosa cultures.

MAIN OUTCOME MEASURES:

The primary end points were time to pulmonary exacerbation requiring intravenous antibiotics and proportion of P aeruginosa -positive cultures.

RESULTS:

The intention-to-treat analysis included 304 participants. There was no interaction between treatments. There were no statistically significant differences in exacerbation rates between cycled and culture-based groups (hazard ratio, 0.95; 95% confidence interval [CI], 0.54-1.66) or ciprofloxacin and placebo (hazard ratio, 1.45; 95% CI, 0.82-2.54). The odds ratios of P aeruginosa- positive culture comparing the cycled vs culture-based group were 0.78 (95% CI, 0.49-1.23) and 1.10 (95% CI, 0.71-1.71) comparing ciprofloxacin vs placebo. Adverse events were similar across groups.

CONCLUSIONS:

No difference in the rate of exacerbation or prevalence of P aeruginosa positivity was detected between cycled and culture-based therapies. Adding ciprofloxacin produced no benefits.

TRIAL REGISTRATION:

ClinicalTrials.gov Identifier: NCT00097773.

PMID:
21893650
PMCID:
PMC3991697
DOI:
10.1001/archpediatrics.2011.136
[Indexed for MEDLINE]
Free PMC Article

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