Duration of intravenous antibiotic treatment for acute exacerbations of cystic fibrosis: A systematic review

Trevor T Nicholson; Aisling Smith; Edward F McKone; Charles G Gallagher

doi:10.1016/j.jcf.2021.08.017

Duration of intravenous antibiotic treatment for acute exacerbations of cystic fibrosis: A systematic review

J Cyst Fibros. 2022 Jul;21(4):562-573. doi: 10.1016/j.jcf.2021.08.017. Epub 2021 Sep 27.

Authors

Trevor T Nicholson¹, Aisling Smith², Edward F McKone³, Charles G Gallagher³

Affiliations

¹ National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Dublin 4, Ireland; UCD School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland. Electronic address: t.nicholson@svhg.ie.
² UCD School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland.
³ National Referral Centre for Adult Cystic Fibrosis, St. Vincent's University Hospital, Dublin 4, Ireland; UCD School of Medicine and Medical Science, University College Dublin, Dublin 4, Ireland.

PMID: 34588142
DOI: 10.1016/j.jcf.2021.08.017

Abstract

Background: Acute exacerbations of Cystic Fibrosis (AECF) are associated with significant morbidity. Recommendations are to treat for 2-3 weeks despite limited data. Spirometry is a measure of clinical response yet appears to plateau at 7-10 days. While durations <9 days have been associated with poorer outcomes, a duration of 10 days may be as effective as 14 days, potentially conferring advantages in terms of cost and adverse events. A 2019 Cochrane review by Abbott et al. did not identify any randomised controlled trials (RCT) comparing durations of treatment. Utilising data from non-randomised studies (NRS), we report a systematic review of intravenous antibiotic treatment, exploring changes in FEV₁ (Forced Expiratory Volume in 1 second), CRP (C-reactive protein) and peripheral WBC (white blood cell) count in studies with different treatment durations.

Study design and methods: Systematic review of published literature following a search of MEDLINE, Embase, CINAHL and the Cochrane Clinical Trials register. Guidelines from the Preferred Reporting items for Systematic reviews and Meta-Analysis (PRISMA) and reporting Meta-analysis of Observational studies (MOOSE) statement were followed.

Results: No randomised controlled trials were identified that specifically examined duration of treatment during AECF. This study included all relevant RCTs and also NRS, grouping according to study characteristics, such as length of treatment, location, year, and also characteristics of the patient population. 52 studies, comprising 79 subgroups, and 1,597 patients, were identified. Mean change (95%CI) in ppFEV₁ was 10.13 (9.21-11.05). There was no significant difference in change in ppFEV₁ for studies treating for 10-12 days; 8.85 (7.47-10.23), vs 13-15 days; 10.68 (9.53-11.82). Similar changes in CRP and WBC were seen irrespective of treatment duration.

Conclusion: This systematic review provides evidence that shorter durations of treatment may be associated with similar changes in FEV₁, CRP and WBC compared with longer durations.

Keywords: Antibiotic; Cystic fibrosis; Duration of treatment; acute exacerbations.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Administration, Intravenous
Anti-Bacterial Agents
Cystic Fibrosis* / complications
Cystic Fibrosis* / diagnosis
Cystic Fibrosis* / drug therapy
Forced Expiratory Volume
Humans

Substances

Anti-Bacterial Agents