Сeftazidime/avibactam in the treatment of exacerbation of a chronic respiratory infection in patients with cystic fibrosis: dynamics of clinical, microbiological, and functional parameters

Abstract

Multidrug resistance of pulmonary pathogens in patients with cystic fibrosis (CF) requires new therapeutic solutions. The aim. To assess the effect of ceftazidime/avibactam (cef/avi) on clinical outcomes of pulmonary exacerbation of cystic fibrosis. Methods. This open single-group observational prospective non-interventional study was conducted in the routine clinical practice settings. Patients over 18 years with a confirmed diagnosis of CF and an exacerbation of a pulmonary infection were included into the study after physician’s decision to prescribe cef/avi. The examinations were performed at baseline and on Days 5 to 7, 21, and 30. Results. The analysis included data from 32 patients, 12 (38%) males and 20 (63%) females. The mean age was 31.6 years. Symptoms of exacerbation persisted in 97 % of patients on Days 5 to 7 of therapy and only in 3% at Day 21. FEV1, FVC, SpO2 also improved by Day 21 of the study (all – p < 0.001). By Day 21, proportion of patients with CRP above 10 mg/ml grew from 71 to 9%. The average density of sputum contamination decreased from 7.2 to 5.5 CFU/ml. Quality of life according to Cystic Fibrosis Questionnaire-Revised (CFQ-R) questionnaire also improved. Conclusion. In patients with CF, exacerbation of lung infection in most cases is caused by multidrug resistant strains of Pseudomonas aeruginosa sometimes in combination with Staphylococcus aureus. Infectious agents (P. aeruginosa) remain highly sensitive to cef/avi (up to 91%) in this population so this justifies the use of cef/avi in treatment of a CF exacerbation. cef/avi administration led to relief of the exacerbation symptoms in 97% CF patients, as well as to significant improvement in spirometry parameters, increase in the oxygenation index, decrease in CRP and density of sputum contamination, and improved the quality of life. cef/avi administration was not associated with lethal outcomes, ICU admission, or serious adverse drug reactions.