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Pediatr Pulmonol. 2015 Jun;50(6):552-9. doi: 10.1002/ppul.23132. Epub 2015 Jan 5.

Utilization of antibiotics for methicillin-resistant Staphylococcus aureus infection in cystic fibrosis.

Author information

1
Department of Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah.
2
Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah.
3
Department of Pharmacy, St. Vincent's Medical Center Riverside, Jacksonville, Florida.
4
L.S. Skaggs Pharmacy Institute Rm 4916, University of Utah College of Pharmacy, Salt Lake City, Utah.
5
Intermountain Cystic Fibrosis Adult Center, Salt Lake City, Utah.
6
Department of Pharmacy, Intermountain McKay-Dee Hospital Center, Ogden, Utah.
7
Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, Utah.
8
Cystic Fibrosis Foundation, Bethesda, Maryland.
9
Departments of Medicine and Pediatrics, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital, Cleveland, Ohio.

Abstract

OBJECTIVES:

The purpose of this study was to characterize the utilization of antibiotics for chronic methicillin-resistant Staphylococcus aureus (MRSA) infection in cystic fibrosis (CF) patients with acute pulmonary exacerbations (PEx).

METHODS:

An anonymous national cross-sectional survey of CF Foundation accredited care programs was performed using an electronic survey tool.

RESULTS:

Fifty-eight percent (152/261) CF Foundation accredited programs completed the survey. Ninety-eight percent (149/152) of respondents reported using antibiotics (oral or intravenous) against MRSA. Variability exists in the use of antibiotics amongst the programs and in the dosages utilized. For oral outpatient treatment, sulfamethoxazole/trimethoprim was the most commonly utilized antibiotic by both pediatric (109/287, 38%) and adult (99/295, 34%) respondents, of which, ten percent of reported to use it in combination with rifampin. For inpatient treatment, linezolid (both intravenous (IV) and oral) was most commonly utilized in both pediatric (IV 35/224, 16%; oral 41/224, 18%), and adult (IV 44/235, 19%; oral 38/235, 16%) respondents for inpatient treatment. IV vancomycin was the second most commonly utilized antibiotic by pediatric (70/224, 31%) and adult (71/235, 30%) respondents. Most respondents reported dose titration to achieve a vancomycin trough level of 15-20 mg/L (150/179, 84%). Topical or inhaled antibiotic utilization was reported to be an uncommon practice with approximately 70% of pediatric and adult respondents reporting to use them either rarely or never. The concomitant use of anti-MRSA and anti-pseudomonal antibiotics was common with 96% of pediatric and 99% of adult respondents answering in the affirmative.

CONCLUSION:

We conclude that anti-MRSA antibiotics are utilized via various dosage regimens by a majority of CF Foundation accredited care programs for the treatment of chronic MRSA in PEx, and there is no consensus on the best treatment approach.

KEYWORDS:

MRSA; anti-staphylococcal antibiotics; infections

PMID:
25559432
DOI:
10.1002/ppul.23132
[Indexed for MEDLINE]

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