View source for Cystic fibrosis pulmonary exacerbation

== Background ==

* Respiratory exacerbation of chronic [[cystic fibrosis]]

== Clinical Manifestations ==

* Increased cough and sputum production
* Increased dyspnea
* Poor appetite, weight loss, occasionally fever, fatigue, reduction in pulmonary function, increased hemoptysis, change in chest radiographic findings, or change in chest physical examination findings (increased rales or rhonchi, decreased air exchange, increased use of accessory muscles of respiration)

== Management ==

* Get sputum cultures
* See [[Cystic fibrosis antibiotic dosing|antibiotic dosing in cystic fibrosis]]
* [[Burkholderia cepacia complex|Burkholderia cepacia]]
** Most important organism to cover, if present
** [[Meropenem]], [[ceftazidime]], inhaled [[tobramycin]], [[doxycycline]], [[TMP-SMX]], [[levofloxacin]]
* [[Pseudomonas aeruginosa]]
** Double coverage
** Beta-lactam plus another ([[fluoroquinolone]], [[colistin]], [[chloramphenicol]], [[aminoglycoside]])
** Treat for 10-14 days and repeat FPTs
* [[Stenotrophomonas maltophilia|Stenotrophomonas]]
** [[TMP-SMX]], [[doxycycline]], [[tigecycline]], [[colistin]], sometimes [[levofloxacin]]
* [[Staphylococcus aureus]]
** MSSA: [[cloxacillin]], [[ceftazidime]], [[TMP-SMX]], [[doxycycline]], [[meropenem]]
** MRSA: [[vancomycin]], [[tigecycline]], [[linezolid]], [[daptomycin]], [[doxycycline]], [[TMP-SMX]]

[[Category:Respirology]]
[[Category:Infectious diseases]]