Cystic Fibrosis Part

Cystic Fibrosis Part ((5)):mortar_board:

Treatment​:arrow_double_down:Continue :arrow_heading_down:

:four_leaf_clover:ORAL ANTIBIOTIC THERAPY​:four_leaf_clover:
:+1: goals to :arrow_right:
:eye:Reduce the intensity of endobronchial infection and delay pro-gressive lung damage.
:eye:Achievement of an independent and productive adulthood is the goal.
:diamond_shape_with_a_dot_inside:Antibiotic treatment varies from intermittent short courses of 1 antibiotic to nearly continuous treatment with 1 or more antibiotics.
:diamond_shape_with_a_dot_inside:Dosages for some antibiotics often 2 to 3 times the amount recommended for minor infections because :arrow_right:it is difficult to achieve effective drug levels of many antimicrobials in respiratory tract secretions.
:diamond_shape_with_a_dot_inside:Indications for oral antibiotic therapy in a patient with CF
:arrow_right: the presence of respiratory tract symptoms
:arrow_right: identification of pathogenic organisms in respira-tory tract cultures.
:diamond_shape_with_a_dot_inside:Common organisms, include(( S. aureus, nontypable Haemophilus influenzae, P. aeruginosa))
:tulip:The first 2 can be eradicated from the respiratory tract in CF with oral antibiotics, but Pseudomonas is more difficult to be treaed orally.
:diamond_shape_with_a_dot_inside:The usual course of therapy ≥2 wk, and maximal doses are recommended.
:diamond_shape_with_a_dot_inside:Infection with mycoplasmal or chlamydial organisms has been documented.

:four_leaf_clover:Aerosol antibiotics​:four_leaf_clover:
:arrow_right: used as an option for home delivery of additional agents, such as tobramycin, colistin, and gentamicin.:baby_chick:
:four_leaf_clover:INTRAVENOUS ANTIBIOTIC​:four_leaf_clover::leftwards_arrow_with_hook:
:sunflower: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.
:sunflower:Treatment of Pseudomonas infection requires 2-drug therapy.
:sunflower:3rd agent may be required for optimal coverage of S. aureus or other organisms.

:writing_hand:Changes in therapy should be guided by lack of improvement and by culture results.
:writing_hand: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.

:four_leaf_clover:Bronchodilator Therapy​:four_leaf_clover:

:diamond_shape_with_a_dot_inside:Reversible airway obstruction can occurs
:diamond_shape_with_a_dot_inside:β-adrenergic agonist aerosol., Cromolyn sodium and ipratropium hydrochlorides are alternative agents, but no evidence support their use.

:four_leaf_clover:Anti-Inflammatory Agents​:four_leaf_clover:

:diamond_shape_with_a_dot_inside:Corticosteroids​:arrow_right:as an alternate-day regimen appeared to improve pulmonary function and diminish hospitalization rates., :diamond_shape_with_a_dot_inside:However long term use found to cause serious side effects​:sob:.

:four_leaf_clover:Endoscopy and Lavage​:four_leaf_clover:
:diamond_shape_with_a_dot_inside: tracheobronchial suctioning or lavage, if atelectasis or mucoid impaction is present.

:diamond_shape_with_a_dot_inside: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.
:four_leaf_clover:MERGING THERAPIES​:four_leaf_clover:
:diamond_shape_with_a_dot_inside:A number of potential therapies under development, including PTC124, denufosol, Moli1901.

:mouse:PROGNOSIS​:mouse:

:palm_tree:CF remains a life-limiting disorder, although survival improved dramatically in the past 30-40 yr.
:palm_tree:Most children survive infancy into relatively healthy adolescence or adulthood.
:palm_tree:Life table data indicate a median cumulative survival exceeding 35 yr.
:palm_tree:Male survival better than female survival for reasons not readily apparent​:hugs:.
:palm_tree:Children in low socioeconomic families have poorer prognosis​:cry:.
:palm_tree:Children with CF have good school attendance records and should not be restricted in their activities.
:palm_tree: A high percentage graduate from college. :palm_tree:Most adults with CF find employment, and marry.
:palm_tree:Achievement of an independent and productive adulthood is the goal.