No additional benefit of antipseudomonal antibiotics for some children with cystic fibrosis

Using anti-Pseudomonas aeruginosa antibiotics may not provide additional benefit for children with cystic fibrosis who were culture negative for P. aeruginosa for at least 1 year, researchers reported.

“Antibiotics are heavily utilized in the care of people with cystic fibrosis, yet limited data exist to help guide antibiotic selection,” Jonathan D. Cogen, MD, MPH, attending physician in the division of pulmonary and sleep medicine at Seattle Children’s Hospital at the University of Washington, Seattle, told Healio. “We believe there are areas of opportunity to limit overall antibiotic exposure in people with cystic fibrosis, with the ultimate goal of maximizing clinical benefits while also minimizing potential antibiotic-related toxicities.”

The retrospective cohort study, published in Annals of American Thoracic Society, utilized the linked Cystic Fibrosis Foundation Patient Registry-Pediatric Health Information System database of 1,290 children aged 6 to 21 years who were hospitalized from 2008 to 2018 with 2,347 pulmonary exacerbations. The children were consistently culture negative for P. aeruginosa for at least 1 year. Overall, 530 children were culture negative for 1 year, 326 for 2 years and 1,492 for 3 years. Providers administered antipseudomonal antibiotics among 79% of children in the 1-year negative group, 67% in the 2-year negative group and 66% in the 3-year negative group.

Compared with non-antipseudomonal antibiotic regimens, treatment with antipseudomonal antibiotics for all P. aeruginosa negative groups was not associated with significant differences in pre- to post-percent predicted FEV₁ treatment change, odds of returning to 90% or higher baseline percent predicted FEV₁ or odds of having a pulmonary exacerbation that requires antibiotics via IV 6 or 12 months following a pulmonary exacerbation during the study.

“Antibiotics targeting P. aeruginosa may not be needed for pulmonary exacerbation treatment among children with cystic fibrosis who have not cultured P. aeruginosa in the prior 12 months,” Cogen told Healio. "We believe more prospective studies are needed evaluating optimal antibiotic pulmonary exacerbation treatment approaches, including a prospective study looking at this question.”

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Jonathan D. Cogen, MD, MPH, can be reached at jonathan.cogen@seattlechildrens.org.