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Do you routinely use two empiric antibiotics to cover for Pseudomonas aeruginosa in the management of CF exacerbations?

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Do you routinely use two empiric antibiotics to cover for Pseudomonas aeruginosa in the management of CF exacerbations?

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5 Answers
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Pulmonology · Indiana University Health
Answered on · Updated on

Historically, two antibiotics have been used to cover Pseudomonas pulmonary exacerbations. The last guidelines were published in 2009 (Flume et al., PMID 19729669 ). At that time, the expert guidelines stated, "The CF Foundation concludes that there is insufficient evidence to recommend the use of a...

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Pulmonology · Hospital of the University of Pennsylvania
Answered on

I fully agree with the answer; from personal experience, I have to say I have been a lot more comfortable and likely to use one antibiotic in recent years than before; this happened mainly because of toxicities and intolerances of aminoglycosides in older patients, so if you ask my personal default ...

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Pulmonology · Medical College of Wisconsin
Answered on

Dual coverage has been the longstanding treatment option for patients with CF. Many are healthier now, live longer, so may have much more drug toxicity from IV aminoglycosides. I have stopped using dual coverage for everyone. I am anxiously awaiting the results of Stop 360.

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Pulmonology · Baylor College of Medicine/St Luke's Episcopal Hospital
Answered on

I love this question and it's one whose answer I struggle with. I find it hard to justify dual agent (since the 2nd one is inevitably toxic as Dr Hadjiliadis noted) in those with a fairly pansensitive Pseudomonas aeruginosa species. I think the resistance pattern does matter. If you have someone wit...

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Infectious Disease · The Cleveland Clinic Foundation
Answered on

Yes, specially if the combination is quinolone + beta lactam, these protect from resistance also inhale tobramycin + beta lactam prevent resistance.

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