Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society · 2025
Evaluating the association of antibiotic spectrum and treatment responses of cystic fibrosis pulmonary exacerbations.
СтатьяПоддержка службы здравоохранения СШАПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Somayaji Ranjani, Cogen Jonathan D, VanDevanter Donald, LiPuma John J, West Natalie E, Sanders Don B, Gerber Jeffrey S, Kronman Matthew P, Goss Christopher H, Flume Patrick A, Heltshe Sonya L
Аннотация
INTRODUCTION: While antibiotics are routinely prescribed for cystic fibrosis (CF) pulmonary exacerbation (PEx) treatment, little evidence exists informing optimal antibiotic selection. This study aimed to determine whether broader-spectrum antibiotics were associated with improved clinical outcomes compared to narrower-spectrum antibiotics for PEx treatment.
METHODS: A secondary analysis of the Standardizing Treatment of Pulmonary Exacerbation-2 (STOP-2) clinical trial was completed. Antibiotic spectrum was defined using the CF antibiotic spectrum index (CF-ASI), a tool that classifies each antibiotic's expected spectrum of antibacterial activity, and was categorized into quartiles (<14, 14-17, 18-22, and >23). Multivariable generalized linear and inverse probability weighted models were constructed to describe the association between ASI and relevant clinical outcomes, including pre- to post-PEx changes in lung function, weight, and CF symptoms scores.
RESULTS: A total of 982 people with CF with a mean age of 30.3 years (SD 9.7) were available for analysis. The median CF-ASI score for the entire cohort was 17 (IQR 13-22). The mean ppFEV1 (difference 0.4, 95% CI -1.4, 2.2, p = 0.80) and CRISS (difference 1.3, 95% CI -2.5, 2.5, p = 0.75) changes from baseline did not differ between the lowest and highest CF-ASI quartiles. In the multivariable analysis, a higher CF-ASI quartile score was not statistically significantly associated with improvements in lung function, symptom score or weight compared to a lower CF-ASI quartile score. Adverse events did not differ in frequency between CF-ASI quartiles.
CONCLUSIONS: Opportunities exist to select narrower-spectrum antibiotics for PEx treatment in CF to minimize the risks of antibiotic toxicities.
METHODS: A secondary analysis of the Standardizing Treatment of Pulmonary Exacerbation-2 (STOP-2) clinical trial was completed. Antibiotic spectrum was defined using the CF antibiotic spectrum index (CF-ASI), a tool that classifies each antibiotic's expected spectrum of antibacterial activity, and was categorized into quartiles (<14, 14-17, 18-22, and >23). Multivariable generalized linear and inverse probability weighted models were constructed to describe the association between ASI and relevant clinical outcomes, including pre- to post-PEx changes in lung function, weight, and CF symptoms scores.
RESULTS: A total of 982 people with CF with a mean age of 30.3 years (SD 9.7) were available for analysis. The median CF-ASI score for the entire cohort was 17 (IQR 13-22). The mean ppFEV1 (difference 0.4, 95% CI -1.4, 2.2, p = 0.80) and CRISS (difference 1.3, 95% CI -2.5, 2.5, p = 0.75) changes from baseline did not differ between the lowest and highest CF-ASI quartiles. In the multivariable analysis, a higher CF-ASI quartile score was not statistically significantly associated with improvements in lung function, symptom score or weight compared to a lower CF-ASI quartile score. Adverse events did not differ in frequency between CF-ASI quartiles.
CONCLUSIONS: Opportunities exist to select narrower-spectrum antibiotics for PEx treatment in CF to minimize the risks of antibiotic toxicities.