Report of the UK Cystic Fibrosis Trust Antibiotic Working Group

8.7 Treatment of Pseudomonas aeruginosa infection – first isolates or in chronicallyinfected patients who have a mild exacerbationA combination of oral ciprofloxacin and nebulised colistin is now widely used to eradicate earlyP.aeruginosa infection (section 5.2.2 for details).Ciprofloxacin orallyAge Dose Frequency Duration1 month–5 years orally 15 mg/kg 12 hourly5–18 years orally 20 mg/kg (max 750 mg) 12 hourlyAdult orally750 mg 12 hourlygive more effective sputum concentrations in adults. 2Pharmacokinetic data suggest that 8 hourly dosing may3 weeks–3 months foreradication. Usually 2weeks for chronicallyinfected patientsPreparationsAdministrationSide-effectsNotes100 mg, 250 mg, 500 mg and 750 mg tablets, 250 mg/5 ml suspension.Do not take milk, indigestion remedies, iron or zinc preparations at the same time as oral preparations.May induce convulsions – taking NSAIDS or theophylline at the same time increases the risk. Other side effectsinclude nausea, vomiting, joint pain, abdominal pain, headache, rash, dizziness, pruritus, hepatitis and jaundice.Nausea commonly resolves with lower doses. A photosensitive skin erythema is relatively common – avoidexposure to strong sunlight. Discontinue if psychiatric, neurological or hypersensitivity reactions occur.Use with caution in epileptic patients. Reduce dose in severe renal impairment. Interacts with a variety ofother drugs including theophylline and NSAIDS. While ciprofloxacin does have activity against gram-positiveinfections, there is a high incidence of resistance in S.aureus after repeated dosing.Colistin inhaledAge Dose Times daily DurationStep 1 All 1 million units 2 3 weeksStep 2 1 month–2 y 1 million units 3 3 weeks≥2y 2 million units 3 3 weeksStep 3 1 month–2 y 1 million units 3 3 months≥2y 2 million units 3 3 months*Step 1 is given for the 1st respiratory isolate of P.aeruginosa, step 2 for the 2nd and step 3 for ALLsubsequent respiratory isolates. Many CF centres will give step 3 (3 months of treatment) from thefirst isolate of P.aeruginosa. 3Preparations500,000unit, 1 million unit and 2 million unit vials.Administration Details in sections 5.10.1 and 5.10.2.Side-effectsNotesBronchospasm – may be prevented by an inhaled bronchodilator. The tendency to bronchoconstriction can bereduced by the use of a more isotonic solution. Transient sensory disturbances.Give first dose in hospital and measure lung function before and after dose.Cystic Fibrosis Trust 8.7March 2009