State of the art in cystic fibrosis pharmacology—Optimization of antimicrobials in the treatment of cystic fibrosis pulmonary exacerbations: I. Anti‐methicillin‐resistant Staphylococcus aureus (MRSA) antibiotics

Acute pulmonary exacerbations (APE) are a complication of cystic fibrosis (CF) and are associated with morbidity and mortality. Methicillin‐resistant Staphylococcus aureus (MRSA) is one of many organisms that has been detected in the airways of patients with CF. This review provides an evidence‐base...

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Bibliographic Details
Published in:Pediatric pulmonology 2020-01, Vol.55 (1), p.33-57
Main Authors: Epps, Quovadis J., Epps, Kevin L., Young, David C., Zobell, Jeffery T.
Format: Article
Language:English
Subjects:
Aminoglycosides
Anti-Bacterial Agents - therapeutic use
antibiotic therapy
Antibiotics
Ceftaroline
Cephalosporins
Ciprofloxacin
Clindamycin
Cystic fibrosis
Cystic Fibrosis - drug therapy
Humans
Linezolid
Lipoglycopeptides
Methicillin
Methicillin-Resistant Staphylococcus aureus - drug effects
MRSA
pharmacology
Rifampin - therapeutic use
Staphylococcus infections
Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
Vancomycin - therapeutic use
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Summary:Acute pulmonary exacerbations (APE) are a complication of cystic fibrosis (CF) and are associated with morbidity and mortality. Methicillin‐resistant Staphylococcus aureus (MRSA) is one of many organisms that has been detected in the airways of patients with CF. This review provides an evidence‐based summary of pharmacokinetic/pharmacodynamic (PK/PD), tolerability, and efficacy studies utilizing anti‐MRSA antibiotics (ie, ceftaroline, clindamycin, fluoroquinolone derivatives (ciprofloxacin, levofloxacin), glycopeptide derivatives (telavancin, vancomycin), linezolid, rifampin, sulfamethoxazole/trimethoprim (SMZ/TMP), and tetracycline derivatives (doxycycline, minocycline, tigecycline) in the treatment of APE and identifies areas where further study is warranted. A recent utilization study of antimicrobials for anti‐MRSA has shown some CF Foundation accredited care centers and affiliate programs are using doses higher than the FDA‐approved doses. Further studies are needed to determine the PK/PD properties in CF patients with clindamycin, minocycline, rifampin, SMZ/TMP, telavancin, and tigecycline; as well as, efficacy and tolerability studies with ciprofloxacin, clindamycin, doxycycline, levofloxacin, minocycline, rifampin, SMZ/TMP, in CF patients with MRSA.
ISSN:8755-6863
1099-0496
DOI:10.1002/ppul.24537