Report of the UK Cystic Fibrosis Trust Antibiotic Working Group

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8. PHARMACOPOEIA8.1 Continuous anti-staphylococcal therapy8.2 Treatment of asymptomatic Staphylococcus aureus isolates or minor exacerbations8.3 Treatment of more severe exacerbations caused by Staphylococcus aureus8.4 Treatment of asymptomatic Haemophilus influenzae carriage or mild exacerbations8.5 Treatment of severe exacerbations of Haemophilus influenzae infection8.6 Treatment of atypical infection, e.g. Mycoplasma and non-tuberculous mycobacteria8.7 Treatment of Pseudomonas aeruginosa infection – first isolates or in chronically infectedpatients who have a mild exacerbation8.8 Treatment of early Pseudomonas aeruginosa infections not cleared by ciprofloxacin andcolistin and of moderate and severe exacerbations of Pseudomonas aeruginosa infection8.8.1 Anti-pseudomonal penicillins8.8.2 Third generation cephalosporins8.8.3 Second-line treatments – Other ß-lactam antibiotics8.8.4 Second-line treatments – Polymyxins8.8.5 Aminoglycisides8.8.6 Other intravenous antibiotics – Fosfomycin8.9 Inhaled anti-pseudomonal antibiotics8.10 Chronic oral anti-pseudomonal therapy8.11 Drugs used in the treatment of Burkholderia cepacia infections8.12 Treatment of more severe Burkholderia cepacia infection8.13 Use of nebulised antimicrobials in chronic Burkholderia cepacia infection8.14 Anti-fungal treatment8.15 Treatment of Stenotrophomonas maltophilia8.16 References9. ANTIBIOTIC-RELATED ALLERGIES AND DESENSITISATION9.1 Extent of the problem9.2 Desensitisation9.3 Recommendations9.4 ReferencesCystic Fibrosis Trust ContentsMarch 2009
GRADING SCHEME FOR LEVELS OF EVIDENCE AND STRENGTH OFRECOMMENDATIONS USED IN ANTIBIOTIC TREATMENT FORCYSTIC FIBROSISThe grading scheme, used in these guidelines is as recommended by the Scottish IntercollegiateGuidelines Network (SIGN). See appendix B of “A Guideline Developer’s Handbook” 2008 edition.http://www.sign.ac.uk/guidelines/fulltext/50/annexb.htmlLevels of evidenceLevel Type of evidence1++ High quality meta-analyses, systematic reviews of RCTs, or RCTs with a very lowrisk of bias1+ Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias1- Meta-analyses, systematic reviews, or RCTs with a high risk of bias2++ High quality systematic reviews of case control or cohort studiesHigh quality case control or cohort studies with a very low risk of confounding orbias and a high probability that the relationship is causal2+ Well-conducted case control or cohort studies with a low risk of confounding or biasand a moderate probability that the relationship is causal2- Case control or cohort studies with a high risk of confounding or bias and asignificant risk that the relationship is not causal3 Non-analytic studies, e.g. case reports, case series4 Expert opinionGrades of recommendationsGrade Type of recommendationABCDAt least one meta-analysis, systematic review, or RCT rated as 1++, and directlyapplicable to the target population; orA body of evidence consisting principally of studies rated as 1+, directly applicable tothe target population, and demonstrating overall consistency of resultsA body of evidence including studies rated as 2++, directly applicable to the targetpopulation, and demonstrating overall consistency of results; orExtrapolated evidence from studies rated as 1++ or 1+A body of evidence including studies rated as 2+, directly applicable to the targetpopulation and demonstrating overall consistency of results; orExtrapolated evidence from studies rated as 2++Evidence level 3 or 4; orExtrapolated evidence from studies rated as 2+Cystic Fibrosis Trust Grading SchemeMarch 2009
Page 3 and 4: 4. ORAL ANTIBIOTICS IN CYSTIC FIBRO
Page 5: 7. OTHER INFECTIONS7.1 Management o
Page 9 and 10: SUMMARY•All young children with c
Page 11: In 1989 the Copenhagen centre recom
Page 15 and 16: These bacteria can be harmless comm
Page 17 and 18: 2.7 Clinical relevance of in vitro
Page 19 and 20: 17. Macia MD, Blanquer D, Togores B
Page 21 and 22: 3.1 Introduction3. IDENTIFICATION O
Page 23 and 24: Table 2: Laboratory techniques and
Page 25 and 26: 20. Hoppe JE, Theurer MU, Stern M.
Page 27 and 28: 4.2.4 Recommendations for treatment
Page 29 and 30: 4.5 Use of oral antibiotics at time
Page 31 and 32: groups in terms of the chronic use
Page 33 and 34: 5.1 Introduction5. NEBULISED ANTIBI
Page 36 and 37: 5.5 Nebulised antibiotics to preven
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Page 42 and 43: 5.16 Nebuliser/compressor systems f
Page 44 and 45: 19. Ratjen F, Walter H, Haug M, Mei
Page 46 and 47: 69. Pitchford KC, Corey M, Highsmit
Page 48 and 49: outcome between active and placebo
Page 50 and 51: Drug Route Age/weight DoseFrequency
Page 52 and 53: much sooner. A minimum of 10-14 day
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7. OTHER INFECTIONS7.1 Management o
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7.2 Respiratory infection with meti
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Table 7.2 Published data on eradica
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7.4.2 Recommendations• Given the
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although not all authors have found
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Table 7.3 Drugs for treatment of My
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7.9.2 Diagnosis of ABPAThe Cystic F
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• It is important to assess the c
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12. Blackburn L, Brownlee K, Conway
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57. Ballestero S, Virseda I, Escoba
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107. Deerojanawong J, Sawyer SM, Fi
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155. Stevens DA, Moss RB, Kurup VP,
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8. PHARMACOPOEIAOriginally based on
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8.3 Treatment of more severe exacer
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Co-amoxiclav orallyAge Dose Frequen
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Cefotaxime intravenouslyAge Dose Fr
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8.7 Treatment of Pseudomonas aerugi
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8.8.3 Other ß-lactam antibioticsTh
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Amikacin intravenouslyAge Dose Freq
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8.10 Chronic oral anti-pseudomonal
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TemocillinAge Dose Frequency>12year
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Liposomal Amphotericin (“Ambisome
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9. ANTIBIOTIC-RELATED ALLERGIES AND
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I N F O R M A T I O NCystic Fibrosi
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Report of the UK Cystic Fibrosis Trust Antibiotic Working Group

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