Cystic fibrosis pulmonary exacerbation: Difference between revisions
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* Get sputum cultures |
* Get sputum cultures |
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* See [[Cystic fibrosis |
* See [[Cystic fibrosis antibiotic dosing|antibiotic dosing in cystic fibrosis]] |
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* |
* [[Burkholderia cepacia complex|Burkholderia cepacia]] |
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** Most important organism to cover, if present |
** Most important organism to cover, if present |
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** Meropenem, ceftazidime, |
** [[Meropenem]], [[ceftazidime]], inhaled [[tobramycin]], [[doxycycline]], [[TMP-SMX]], [[levofloxacin]] |
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* |
* [[Pseudomonas aeruginosa]] |
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** Double coverage |
** Double coverage |
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** Beta-lactam plus another ( |
** Beta-lactam plus another ([[fluoroquinolone]], [[colistin]], [[chloramphenicol]], [[aminoglycoside]]) |
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** Treat for 10-14 days and repeat FPTs |
** Treat for 10-14 days and repeat FPTs |
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* |
* [[Stenotrophomonas maltophilia|Stenotrophomonas]] |
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** |
** [[TMP-SMX]], [[doxycycline]], [[tigecycline]], [[colistin]], sometimes [[levofloxacin]] |
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* |
* [[Staphylococcus aureus]] |
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** MSSA: cloxacillin, ceftazidime, |
** MSSA: [[cloxacillin]], [[ceftazidime]], [[TMP-SMX]], [[doxycycline]], [[meropenem]] |
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** MRSA: vancomycin, tigecycline, linezolid, daptomycin, doxycycline, |
** MRSA: [[vancomycin]], [[tigecycline]], [[linezolid]], [[daptomycin]], [[doxycycline]], [[TMP-SMX]] |
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[[Category:Respirology]] |
[[Category:Respirology]] |
Revision as of 15:12, 20 June 2023
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