Cystic Fibrosis Part ((5))
Treatment:arrow_double_down:Continue
ORAL ANTIBIOTIC THERAPY:four_leaf_clover:
goals to
Reduce the intensity of endobronchial infection and delay pro-gressive lung damage.
Achievement of an independent and productive adulthood is the goal.
Antibiotic treatment varies from intermittent short courses of 1 antibiotic to nearly continuous treatment with 1 or more antibiotics.
Dosages for some antibiotics often 2 to 3 times the amount recommended for minor infections because it is difficult to achieve effective drug levels of many antimicrobials in respiratory tract secretions.
Indications for oral antibiotic therapy in a patient with CF
the presence of respiratory tract symptoms
identification of pathogenic organisms in respira-tory tract cultures.
Common organisms, include(( S. aureus, nontypable Haemophilus influenzae, P. aeruginosa))
The first 2 can be eradicated from the respiratory tract in CF with oral antibiotics, but Pseudomonas is more difficult to be treaed orally.
The usual course of therapy ≥2 wk, and maximal doses are recommended.
Infection with mycoplasmal or chlamydial organisms has been documented.
Aerosol antibiotics:four_leaf_clover:
used as an option for home delivery of additional agents, such as tobramycin, colistin, and gentamicin.
INTRAVENOUS ANTIBIOTIC:four_leaf_clover:
For patient who has pro-gressive symptoms and signs despite intensive home measures, Although many patients show improvement within 7 days, it is usually advisable to extend the period of treatment to at least 14 days.
Treatment of Pseudomonas infection requires 2-drug therapy.
3rd agent may be required for optimal coverage of S. aureus or other organisms.
Changes in therapy should be guided by lack of improvement and by culture results.
If patients do not show improvement, complications such as heart failure and reactive airways or infection with viruses, Aspergillus fumigatus, nontuberculous mycobacteria , or other unusual organisms should be considered.
Bronchodilator Therapy:four_leaf_clover:
Reversible airway obstruction can occurs
β-adrenergic agonist aerosol., Cromolyn sodium and ipratropium hydrochlorides are alternative agents, but no evidence support their use.
Anti-Inflammatory Agents:four_leaf_clover:
Corticosteroids:arrow_right:as an alternate-day regimen appeared to improve pulmonary function and diminish hospitalization rates., However long term use found to cause serious side effects:sob:.
Endoscopy and Lavage:four_leaf_clover:
tracheobronchial suctioning or lavage, if atelectasis or mucoid impaction is present.
Antibiotics (usually gentamicin or tobramycin) can be instilled directly at lavage to transiently achieve a much higher endobronchial concentration than can be obtained by using intravenous therapy.
MERGING THERAPIES:four_leaf_clover:
A number of potential therapies under development, including PTC124, denufosol, Moli1901.
PROGNOSIS:mouse:
CF remains a life-limiting disorder, although survival improved dramatically in the past 30-40 yr.
Most children survive infancy into relatively healthy adolescence or adulthood.
Life table data indicate a median cumulative survival exceeding 35 yr.
Male survival better than female survival for reasons not readily apparent:hugs:.
Children in low socioeconomic families have poorer prognosis:cry:.
Children with CF have good school attendance records and should not be restricted in their activities.
A high percentage graduate from college. Most adults with CF find employment, and marry.
Achievement of an independent and productive adulthood is the goal.