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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.

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Department of Pharmacy, Intermountain Primary Children's Hospital, Salt Lake City, Utah.
Intermountain Cystic Fibrosis Pediatric Center, Salt Lake City, Utah.
Department of Pharmacy, St. Vincent's Medical Center Riverside, Jacksonville, Florida.
L.S. Skaggs Pharmacy Institute Rm 4916, University of Utah College of Pharmacy, Salt Lake City, Utah.
Intermountain Cystic Fibrosis Adult Center, Salt Lake City, Utah.
Department of Pharmacy, Intermountain McKay-Dee Hospital Center, Ogden, Utah.
Division of Pediatric Infectious Disease, University of Utah, Salt Lake City, Utah.
Cystic Fibrosis Foundation, Bethesda, Maryland.
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.



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).


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


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.


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.


MRSA; anti-staphylococcal antibiotics; infections

[Indexed for MEDLINE]

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