Prévotat A, Leroy S, Perez T, Wallet F, Wallaert B
CRCM adultes, service de pneumologie et immuno-allergologie, hôpital Calmette, CHRU de Lille, boulevard du Professeur Leclercq, 59037 Lille, France.
Rev Mal Respir. 2010 May;27(5):449-56. doi: 10.1016/j.rmr.2010.03.015. Epub 2010 Apr 28.
Antibiotic therapy for acute pulmonary exacerbations in patients with cystic fibrosis is usually chosen based on the results of antimicrobial susceptibility. This can be difficult when bacteria are multiresistant. The objective of this retrospective study was to evaluate the tolerance and efficiency of ceftazidime and aztreonam combination (+/-tobramycin, +/-ciprofloxacin) in the treatment of acute exacerbations in cystic fibrosis patients who were chronically colonized with multiresistant P. aeruginosa.
Seventeen severe patients, with FEV(1)=1070+/-66 mL and BMI=18+/-0.6 kg/m(2), who had chronic colonisation with P. aeruginosa with intermediate sensitivity or resistance to ceftazidime and aztreonam, were studied between June 2003 and March 2007. Oxygen saturation, dyspnoea, weight, FEV(1), FVC, and tolerance were evaluated before and after antibiotic courses.
Forty-two courses of treatment, administered between June 2003 and March 2007 were studied: Patients increased their FEV(1) and FVC (p=0.01). One antibiotic course was stopped after four days because of cutaneous side effects. The median delay until the next exacerbation was 101+/-10 days. These courses were compared with other combinations of antibiotics that the patients had received before. The combination of ceftazidime and aztreonam was more effective in patients receiving less than four courses per year for acute pulmonary exacerbation.
In chronically P. aeruginosa colonised cystic fibrosis patients, ceftazidime and aztreonam combination (+/-tobramycin, +/-ciprofloxacin) is well tolerated and efficient. This treatment suggests a clinical and functional benefit is possible, even in patients with severe disease.
囊性纤维化患者急性肺部加重期的抗生素治疗通常根据抗菌药敏结果来选择。当细菌具有多重耐药性时，这可能会很困难。这项回顾性研究的目的是评估头孢他啶和氨曲南联合使用（±妥布霉素，±环丙沙星）治疗长期定植有多重耐药铜绿假单胞菌的囊性纤维化患者急性加重期的耐受性和疗效。
2003年6月至2007年3月期间研究了17例重症患者，其第1秒用力呼气容积（FEV₁）=1070±66毫升，体重指数（BMI）=18±0.6千克/平方米，长期定植有对头孢他啶和氨曲南中度敏感或耐药的铜绿假单胞菌。在抗生素疗程前后评估了血氧饱和度、呼吸困难、体重、FEV₁、用力肺活量（FVC）和耐受性。
研究了2003年6月至2007年3月期间给予的42个疗程的治疗：患者的FEV₁和FVC增加（p=0.01）。由于皮肤副作用，一个抗生素疗程在四天后停止。直到下一次加重的中位间隔时间为101±10天。将这些疗程与患者之前接受的其他抗生素组合进行了比较。头孢他啶和氨曲南联合使用对每年急性肺部加重期接受少于四个疗程治疗的患者更有效。
在长期定植有铜绿假单胞菌的囊性纤维化患者中（±妥布霉素，±环丙沙星），头孢他啶和氨曲南联合使用耐受性良好且有效。这种治疗表明即使在重症患者中也可能有临床和功能益处。
