Cystic fibrosis pulmonary exacerbation: Difference between revisions

Latest revision as of 15:13, 20 June 2023

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 antibiotic dosing in cystic fibrosis
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
- TMP-SMX, doxycycline, tigecycline, colistin, sometimes levofloxacin
Staphylococcus aureus
- MSSA: cloxacillin, ceftazidime, TMP-SMX, doxycycline, meropenem
- MRSA: vancomycin, tigecycline, linezolid, daptomycin, doxycycline, TMP-SMX

@@ Line 1: / Line 1: @@
-== Clinical Presentation ==
+== Background ==
+* Respiratory exacerbation of chronic [[cystic fibrosis]]
+== Clinical Manifestations ==
 * Increased cough and sputum production
@@ Line 8: / Line 12: @@
 * Get sputum cultures
-* See [[Cystic fibrosis (CF) antibiotic dosing]]
+* See [[Cystic fibrosis antibiotic dosing|antibiotic dosing in cystic fibrosis]]
-* ''Burkholderia cepacia''
+* [[Burkholderia cepacia complex|Burkholderia cepacia]]
 ** Most important organism to cover, if present
-** Meropenem, ceftazidime, tobi, doxy, Septra, levo
+** [[Meropenem]], [[ceftazidime]], inhaled [[tobramycin]], [[doxycycline]], [[TMP-SMX]], [[levofloxacin]]
-* ''Pseudomonas''
+* [[Pseudomonas aeruginosa]]
 ** Double coverage
-** Beta-lactam plus another (quinolone, colistin, chloramphenicol, aminoglycoside)
+** Beta-lactam plus another ([[fluoroquinolone]], [[colistin]], [[chloramphenicol]], [[aminoglycoside]])
 ** Treat for 10-14 days and repeat FPTs
-* ''Stenotrophomonas''
+* [[Stenotrophomonas maltophilia|Stenotrophomonas]]
-** Septra, doxycycline, tigecycline, colistin, sometimes levofloxacin
+** [[TMP-SMX]], [[doxycycline]], [[tigecycline]], [[colistin]], sometimes [[levofloxacin]]
-* ''Staph. aureus''
+* [[Staphylococcus aureus]]
-** MSSA: cloxacillin, ceftazidime, Septra, doxycycline, meropenem
+** MSSA: [[cloxacillin]], [[ceftazidime]], [[TMP-SMX]], [[doxycycline]], [[meropenem]]
-** MRSA: vancomycin, tigecycline, linezolid, daptomycin, doxycycline, Septra
+** MRSA: [[vancomycin]], [[tigecycline]], [[linezolid]], [[daptomycin]], [[doxycycline]], [[TMP-SMX]]
 [[Category:Respirology]]