Cystic fibrosis pulmonary exacerbation

Clinical Presentation

• 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 (CF) antibiotic dosing
• Burkholderia cepacia
  • Most important organism to cover, if present
  • Meropenem, ceftazidime, tobi, doxy, Septra, levo
• Pseudomonas
  • Double coverage
  • Beta-lactam plus another (quinolone, colistin, chloramphenicol, aminoglycoside)
  • Treat for 10-14 days and repeat FPTs
• Stenotrophomonas
  • Septra, doxycycline, tigecycline, colistin, sometimes levofloxacin
• Staph. aureus
  • MSSA: cloxacillin, ceftazidime, Septra, doxycycline, meropenem
  • MRSA: vancomycin, tigecycline, linezolid, daptomycin, doxycycline, Septra