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Meta-Analysis
. 2016 Jul 14;7(7):CD005405.
doi: 10.1002/14651858.CD005405.pub4.

Oral anti-pseudomonal antibiotics for cystic fibrosis

Tracey Remmington  1 , Nikki Jahnke, Christian Harkensee
Affiliations
Meta-Analysis

Oral anti-pseudomonal antibiotics for cystic fibrosis

Tracey Remmington et al. Cochrane Database Syst Rev. .

Abstract

Background: Pseudomonas aeruginosa is the most common bacterial pathogen causing lung infections in people with cystic fibrosis and appropriate antibiotic therapy is vital. Antibiotics for pulmonary exacerbations are usually given intravenously, and for long-term treatment, via a nebuliser. Oral anti-pseudomonal antibiotics with the same efficacy and safety as intravenous or nebulised antibiotics would benefit people with cystic fibrosis due to ease of treatment and avoidance of hospitalisation. This is an update of a previous review.

Objectives: To determine the benefit or harm of oral anti-pseudomonal antibiotic therapy for people with cystic fibrosis, colonised with Pseudomonas aeruginosa, in the:1. treatment of a pulmonary exacerbation; and2. long-term treatment of chronic infection.

Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.We contacted pharmaceutical companies and checked reference lists of identified trials.Date of last search: 08 July 2016.

Selection criteria: Randomised or quasi-randomised controlled trials comparing any dose of oral anti-pseudomonal antibiotics, to other combinations of inhaled, oral or intravenous antibiotics, or to placebo or usual treatment for pulmonary exacerbations and long-term treatment.

Data collection and analysis: Two authors independently selected the trials, extracted data and assessed quality. We contacted trial authors to obtain missing information.

Main results: We included three trials examining pulmonary exacerbations (171 participants) and two trials examining long-term therapy (85 participants). We regarded the most important outcomes as quality of life and lung function. The analysis did not identify any statistically significant difference between oral anti-pseudomonal antibiotics and other treatments for these outcome measures for either pulmonary exacerbations or long-term treatment. One of the included trials reported significantly better lung function when treating a pulmonary exacerbation with ciprofloxacin when compared with intravenous treatment; however, our analysis did not confirm this finding. We found no evidence of difference between oral anti-pseudomonal antibiotics and other treatments regarding adverse events or development of antibiotic resistance, but trials were not adequately powered to detect this. None of the studies had a low risk of bias from blinding which may have an impact particularly on subjective outcomes such as quality of life. The risk of bias for other criteria could not be clearly stated across the studies.

Authors' conclusions: We found no conclusive evidence that an oral anti-pseudomonal antibiotic regimen is more or less effective than an alternative treatment for either pulmonary exacerbations or long-term treatment of chronic infection with P. aeruginosa. Until results of adequately-powered future trials are available, treatment needs to be selected on a pragmatic basis, based upon any available non-randomised evidence, the clinical circumstances of the individual, the known effectiveness of drugs against local strains and upon individual preference.

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Conflict of interest statement

None known.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Pulmonary exacerbation ‐ oral versus IV antibiotics, Outcome 1 FEV1 ml (mean change).
1.2
1.2. Analysis
Comparison 1 Pulmonary exacerbation ‐ oral versus IV antibiotics, Outcome 2 FVC ml (mean change).
1.3
1.3. Analysis
Comparison 1 Pulmonary exacerbation ‐ oral versus IV antibiotics, Outcome 3 Adverse events.
1.4
1.4. Analysis
Comparison 1 Pulmonary exacerbation ‐ oral versus IV antibiotics, Outcome 4 Frequency of need for additional antibiotic use.
1.5
1.5. Analysis
Comparison 1 Pulmonary exacerbation ‐ oral versus IV antibiotics, Outcome 5 Isolation of antibiotic‐resistant strains ‐ P. aeruginosa.
1.6
1.6. Analysis
Comparison 1 Pulmonary exacerbation ‐ oral versus IV antibiotics, Outcome 6 Isolation of antibiotic‐resistant strains ‐ S. aureus.
2.1
2.1. Analysis
Comparison 2 Long‐term treatment ‐ oral versus oral and inhaled antibiotics, Outcome 1 Isolation of antibiotic‐resistant strains ‐ P. aeruginosa.
3.1
3.1. Analysis
Comparison 3 Long‐term treatment ‐ oral versus placebo, Outcome 1 Mean FEV1 at end of course (L).
3.2
3.2. Analysis
Comparison 3 Long‐term treatment ‐ oral versus placebo, Outcome 2 Mean FVC at end of course (L).
3.3
3.3. Analysis
Comparison 3 Long‐term treatment ‐ oral versus placebo, Outcome 3 Mortality.
3.4
3.4. Analysis
Comparison 3 Long‐term treatment ‐ oral versus placebo, Outcome 4 Weight (kg).
3.5
3.5. Analysis
Comparison 3 Long‐term treatment ‐ oral versus placebo, Outcome 5 Adverse events.
3.6
3.6. Analysis
Comparison 3 Long‐term treatment ‐ oral versus placebo, Outcome 6 Participants needing additional IV courses.
3.7
3.7. Analysis
Comparison 3 Long‐term treatment ‐ oral versus placebo, Outcome 7 Isolation of antibiotic‐resistant strains ‐ P. aeruginosa.
3.8
3.8. Analysis
Comparison 3 Long‐term treatment ‐ oral versus placebo, Outcome 8 Isolation of antibiotic‐resistant strains ‐ S. aureus.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Hodson 1987 {published data only}
    1. Hodson ME, Roberts CM, Butland RJA, Batten JC. Ciprofloxacin compared with intravenous azlocillin and gentamicin in the treatment of Pseudomonas aeruginosa infection in cystic fibrosis (CF) [abstract]. Pediatric Pulmonology 1987;3(2):126.
    1. Hodson ME, Roberts CM, Butland RJA, Batten JC. Ciprofloxacin compared with intravenous azlocillin and gentamicin in the treatment of Pseudomonas aeruginosa infection in cystic fibrosis (CF) [abstract]. Proceedings of the 14th Annual Meeting of the European Working Group for Cystic Fibrosis; 1‐2 September 1986; Budapest. 1986:20.
    1. Hodson ME, Roberts CM, Butland RJA, Smith MJ. Oral ciprofloxacin compared with conventional intravenous treatment for Pseudomonas aeruginosa infection in adults with cystic fibrosis. Lancet 1987;1(8527):235‐7. - PubMed
Richard 1997 {published and unpublished data}
    1. Richard DA, Nousia‐Arvanitakis S, Sollich V, Hampel BJ, Sommerauer B, Schaad UB. Oral ciprofloxacin vs. intravenous ceftazidime plus tobramycin in pediatric cystic fibrosis patients: comparison of antipseudomonas efficacy and assessment of safety with ultrasonography and magnetic resonance imaging. Pediatric Infectious Disease Journal 1997;16(6):572‐8. - PubMed
Schaad 1997 {published and unpublished data}
    1. Schaad UB, Wedgwood J, Ruedeberg A, Kraemer R, Hampel B. Ciprofloxacin as antipseudomonal treatment in patients with cystic fibrosis. Pediatric Infectious Disease Journal 1997;16(6):106‐11. - PubMed
Sheldon 1993 {published data only}
    1. Assoufi BK, Sheldon CD, Hodson ME. Double blind comparison of regular 3 monthly treatment with ciprofloxacin or placebo in cystic fibrosis patients who are chronically colonised with Pseudmonas aeruginosa [abstract]. Pediatric Pulmonology 1990;Suppl 5:204.
    1. Assoufi BK, Sheldon CD, Hodson ME. Double blind comparison of regular three monthly treatment with ciprofloxacin or placebo in cystic fibrosis (CF) patients who are chronically colonised with Pseudmonas aeruginosa [abstract]. 16th Annual Meeting of the European Working Group for Cystic Fibrosis; 1989; Prague, Czechoslovakia. 1989:32.
    1. Sheldon CD, Assoufi BK, Hodson ME. Regular three monthly oral ciprofloxacin in adult cystic fibrosis patients infected with Pseudomonas aeruginosa. Respiratory Medicine 1993;87:587‐93. - PubMed
Wang 1988 {published data only}
    1. Wang CI, Inderlied CB, Armer C, Roldan MA, Osher AB. Comparison of the efficacy and safety of oral ciprofloxacin with that of i.v. tobramycin plus azlocillin and/or tobramycin plus ticarcillin in patients with cystic fibrosis [abstract]. Excerpta Medica, Asia Pacific Congress Series 1988;74:R(c)19.

References to studies excluded from this review

Anstead 2001 {published data only}
    1. Anstead M, Kuhn RJ, Halsey S, Doherty DE, D'Souza N, Kanga JF. Effect of azithromycin on lung function, sputum bacteriology, and sputum inflammatory markers in cystic fibrosis [abstract]. American Journal of Respiratory and Critical Care Medicine 2001;163(5 Suppl):A565.
Beringer 2012 {published data only}
    1. Beringer P, Owens H, Nguyen A, Benitez D, Boyd‐King A, Rao AP. Safety, pharmacokinetics and preliminary evaluation of the antiinflammatory effect of doxycycline in CF [abstract]. Pediatric Pulmonology 2010;45 Suppl 33:370, Abstract no: 422. [CENTRAL: 867114; CFGD Register: PI256a; CRS: 5500100000011256]
    1. Beringer PM, Owens H, Nguyen A, Benitez D, Rao A, D'Argenio DZ. Pharmacokinetics of doxycycline in adults with cystic fibrosis. Antimicrobial Agents and Chemotherapy 2012;56(1):70‐4. [CFGD Register: PI256b] - PMC - PubMed
Black 1991 {published data only}
    1. Black A, Redmond A, Scott E. Randomised study comparing courses or oral ciprofloxacin alone with intermittent courses of intravenous azlocillin plus tobramycin or oral ciprofloxacin in the treatment of acute exacerbations of respiratory infection in cystic fibrosis [abstract]. Proceedings of the 16th Annual Meeting of the European Working Group for Cystic Fibrosis; 1989; Prague, Czechoslovakia. 1989:31.
    1. Black A, Redmond AOB, Steen HJ, Oborska IT. Tolerance and safety of ciprofloxacin in paediatric patients. Journal of Antimicrobial Chemotherapy 1990;26(Suppl F):25‐9. - PubMed
    1. Black A, Stevenson M, Scott E, Redmond A. Randomised study comparing oral ciprofloxacin alone with ciprofloxacin alternating with intravenous therapy in cystic fibrosis [abstract]. Proceedings of the 17th European Cystic Fibrosis Conference; 1991 June 18‐21; Copenhagen, Denmark. 1991:80.
Bosso 1987 {published data only}
    1. Bosso JA, Black PG, Matsen JM. Ciprofloxacin versus tobramycin plus azlocillin in pulmonary exacerbations in adult patients with cystic fibrosis. American Journal of Medicine 1987;82(Suppl 4a):180‐4. - PubMed
Bosso 1989 {published data only}
    1. Bosso JA. Use of ciprofloxacin in cystic fibrosis patients. American Journal of Medicine 1989;87(Suppl 5a):123s‐7s. - PubMed
Cipolli 2001 {published data only}
    1. Cipolli M, Cazzola G, Novelli A, Cassetta MI, Fallani S, Mazzeri T. Azithromycin concentrations in serum bronchial secretions of patients with cystic fibrosis. Clinical Drug Investigation 2001;21(5):353‐60.
Connett 2015 {published data only}
    1. Connett GJ, Pike KC, Legg JP, Cathie K, Dewar A, Foote K, et al. Ciprofloxacin during upper respiratory tract infections to reduce Pseudomonas aeruginosa infection in paediatric cystic fibrosis: a pilot study. Therapeutic Advances in Respiratory Disease 2015;9(6):272‐80. [CFGD Register: PI282b; CRS: 5500135000001465; PUBMED: 26341118] - PubMed
    1. Legg J, Pike K, Cathie K, Dewar A, Foote K, Harris A, et al. A randomized double‐blind, placebo‐controlled trial of ciprofloxacin in the treatment of upper respiratory tract infections in children with cystic fibrosis [ abstract]. Pediatric Pulmonology 2014;49 Suppl 38:333, Abstract no: 325. [CENTRAL: 1012529; CFGD Register: PI282a; CRS: 5500131000000185]
Davies 1987 {published data only}
    1. Davies RL, Koup JR, Williams‐Warren J, Weber A, Heggen L, Stempel D, et al. Pharmacokinetics of ciprofloxacin in cystic fibrosis. Antimicrobial Agents and Chemotherapy 1987;31(6):915‐9. - PMC - PubMed
Denning 1977 {published data only}
    1. Denning CR, Park S, Grece CA, Mellin GW. Continuous vs intermittent oral antibiotics in the management of patients with cystic fibrosis [abstract]. Proceedings of the 18th Annual Meeting Cystic Fibrosis Club Abstracts; 1977. 1977:23.
Equi 2002 {published data only}
    1. Equi A, Balfour‐Lynn IM, Bush A, Rosenthal M. Long term azithromycin in children with cystic fibrosis: a randomised, placebo‐controlled crossover trial. Lancet 2002;360(9338):978‐84. - PubMed
    1. Equi A, Bush A, Alton EW, Balfour‐Lynn I, Rosenthsal M. A prospective double‐blind randomised placebo controlled crossover trial of long term azithromycin in children [abstract]. Pediatric Pulmonology 2001;Suppl 22:307.
    1. Equi A, Bush A, Balfour‐Lynn IM, Rosenthsal M. A prospective double‐blind randomised placebo controlled crossover trial of azithromycin in paediatric cystic fibrosis [abstract]. Thorax 2002;57(Suppl iii):38.
Frederiksen 2003 {published data only}
    1. Frederiksen B, Hansen A, Koch C, Hoiby N. Delay of recurrence of Pseudomonas aeruginosa in patients with cystic fibrosis with inhaled colistin and oral ciprofloxacin: a comparison between 3 weeks and 3 months of treatment [abstract]. Pediatric Pulmonology 1997;23 Suppl 14:288, Abstract no: 298. [CFGD Register: PI118a]
    1. Frederiksen B, Pressler T, Koch C, Hoiby N. Endpoints for evaluating early anti‐pseudomonal treatment: changes in pseudomonas prevalence and in pulmonary function [abstract]. Pediatric Pulmonology 2003;36 Suppl 25:334. [CFGD Register: PI118b; ]
Goldfarb 1986 {published data only}
    1. Goldfarb J, Wormser GP, Inchiosa MA, Guideri G, Diaz M, Gandhi R, et al. Single dose pharmacokinetics of oral ciprofloxacin in patients with cystic fibrosis. Journal of Clinical Pharmacology 1986;26:222‐6. - PubMed
Harrison 1985 {published data only}
    1. Harrison CJ, Marks MI, Welch DF, Sharma BB, Baker D, Dice J, et al. A multicenter comparison of related pharmacologic features of cephalexin and dicloxacillin given for two months to young children with cystic fibrosis. Pediatric Pharmacology 1985;5(1):7‐16. - PubMed
Jensen 1987 {published data only}
    1. Jensen T, Pedersen SS, Høiby N, Koch C. Efficacy of oral fluoroquinolones versus conventional intravenous antipseudomonal chemotherapy in treatment of cystic fibrosis. European Journal of Clinical Microbiology 1987;6(6):618‐22. - PubMed
    1. Jensen T, Pedersen SS, Nielsen CH, Hoiby N, Koch C. The efficacy and safety of ciprofloxacin and ofloxacin in chronic Pseudomonas aeruginosa infection in cystic fibrosis. Journal of Antimicrobial Chemotherapy 1987;20(4):585‐94. - PubMed
    1. Pedersen SS, Jensen T, Hvidberg EF. Comparative pharmacokinetics of ciprofloxacin and ofloxacin in cystic fibrosis patients. Journal of Antimicrobial Chemotherapy 1987;20(4):575‐83. - PubMed
Johansen 1999 {published data only}
    1. Johansen HK, Børch K, Espersen F, Koch C, Høiby N. Pivmecillinam + pivampicillin vs. pivampicillin in cystic fibrosis patients with Haemophilus influenzae infection [abstract]. Proceedings of 17th European Cystic Fibrosis Conference; 1991 June 18‐21; Copenhagen, Denmark. 1991:89.
    1. Johansen HK, Børch K, Espersen F, Koch C, Høiby N. Randomised trial of pivampicillin plus pivmecillinam vs. pivampicillin in children and youg adults with chronic obstructive pulmonary disease and infection with Haemophilus influenzae. Current Medical Research and Opinion 1999;15(4):300‐9. - PubMed
Kapranov 1995 {published data only}
    1. Kapranov NI, Belousov YB, Kashyrskaya NY, Smirnova EY. Quinoline therapy in children with cystic fibrosis [abstract]. Proceedings of 20th European Cystic Fibrosis Conference; 1995 June 18‐21; Brussels, Belgium. 1995:P19.
Knight 1979 {published data only}
    1. Knight RK, Batten JC, Mearns M. A double blind trial of cephalexin in cystic fibrosis patients with Pseudomonas in their sputum. Proceedings of 9th Meeting European Working Group for Cystic Fibrosis; 1979 June 12‐13; Noordwijkerhout, The Netherlands. 1979:52.
Kurz 1987 {published data only}
    1. Kurz CC, Marget W, Harms K, Bertele RM. A cross‐over study on the effectiveness of ofloxacin and ciprofloxacin administered orally [Kreuzstudie über die Wirksamkeit von Ofloxacin und Cirpofolxacin bei oraler Anwendung]. Infection 1986;14(Suppl 1):S82‐S86. - PubMed
    1. Kurz CC, Marget W, Harms K, Bertele RM. Comparison of ciprofloxacin and ofloxacin in cystic fibrosis: a cross‐over study [Vergleichende Untersuchung mit Ciprofloxacin und Ofloxacin im Kreuzversuch bei zystischer Fibrose]. Fortschritte der Antimikrobiellen u. Antineoplastischen Chemotherapie 1987;6:2107‐13.
Loening‐Baucke 1979 {published data only}
    1. Loening‐Baucke V, Mischler EH, Myers MG. A placebo‐controlled trial of cephalexin therapy in the ambulatory management of patients with cystic fibrosis. Journal of Pediatrics 1979;95(4):630‐7. - PubMed
    1. Loening‐Baucke V, Mischler EH, Myers MG. Cephalexin compared to placebo in the management of patients with cystic fibrosis [abstract]. Cystic Fibrosis Club Abstracts. 1978:69.
    1. Loening‐Baucke V, Mischler EH, Myers MG. Cephalexin in cystic fibrosis: a placebo‐controlled study [abstract]. Pediatric Research 1978;12(4 Pt 2):495.
Mack 1991 {published data only}
    1. Mack G, Cooper PJ, Buchannan N. Effects of enzyme supplementation on oral absorption of ciprofloxacin in patients with cystic fibrosis. Antimicrobial Agents and Chemotherapy 1991;35(7):1484‐5. - PMC - PubMed
Nolan 1982 {published data only}
    1. Nolan G, McIvor P, Levison H, Fleming PC, Corey M, Gold R. Antibiotic prophylaxis in cystic fibrosis: inhaled cephaloridine as an adjunct to oral cloxacillin. Journal of Pediatrics 1982;101(4):626‐30. - PubMed
Ordonez 2001a {published data only}
    1. Ordonex CL, Stulbarg M, Grundland H, Liu JT, Boushey HA. Effect of clarithromycin on airway obstruction and inflammatory markers in induced sputum in cystic fibrosis. Pediatric Pulmonology 2001;32(1):29‐37. - PubMed
Owen 1991 {published data only}
    1. Owen G, West J, Macguire S, Riley H, Goodchild M, Weller P. Continuous and intermittent antibiotic therapy in CF patients to age four years [abstract]. Proceedings of 17th European Cystic Fibrosis Conference; 1991 June 18‐21; Copenhagen, Denmark. 1991:95.
    1. West J, Smith AW, Brown MRW, Weller PH. The longitudinal relationship between clinical status lung infection and immune responses in young cystic fibrosis patients [abstract]. Pediatric Pulmonology 1990;Suppl 5:222.
    1. Williams J, Alfaham M, Riley HC, Goodchild MC, Weller PH, Dodge JA. Screening for cystic fibrosis in Wales and the West Midlands. 2: Clinical Evaluation [abstract]. Excerpta Medica, Asia Pacific Congress Series 1988;74:G(b)3.
Pai 2006 {published data only}
    1. Pai MP, Allen SE, Amsden GW. Altered steady state pharmacokinetics of levofloxacin in adult cystic fibrosis patients receiving calcium carbonate. Journal of Cystic Fibrosis 2006; Vol. 5, issue 3:153‐7. [MEDLINE: ] - PubMed
Pirzada 1999 {published data only}
    1. Pirzada OM, Taylor CJ. Long term macrolide antibiotics improve pulmonary function in cystic fibrosis [abstract]. Pedaitric Pulmonology 1999;28(Suppl 19):263.
Postnikov 2001a {published data only}
    1. Postnikov SS, Semykin SJ, Najimov VP. Safety of fluoroquinolones in children [abstract]. Proceedings of 24th European Cystic Fibrosis Conference; 2001 June 6‐9; Vienna, Austria. 2001:P213.
Postnikov 2001b {published data only}
    1. Postnikov SS, Yu S, Semykin V, Nazhimov P, Kapranov NI. Comparative growth rate of a year at the children with mucoviscidosis treated and not treated with Ciprofloxacin: clinicomorphological comparisons. Antibiotiki I Khimioterapiia 2001;46(10):11‐3. - PubMed
Pukhalsky 2001 {published data only}
    1. Pukhalsky AL, Shmarina GV, Kapranov NI, Kashirskaja NJ, Kokarovtseva SN, Shabalova LA, et al. Increase of the sputum neutrophil elastase activity is a paradoxical effect of the successful lung disease treatment in cystic fibrosis [abstract]. Pediatric Pulmonology 2001;Suppl 22:274.
Romano 1991 {published data only}
    1. Romano L, Girosi D, Spallone E, Parisi F, Minicucci L, Romano C. The use of ofloxacin in cystic fibrosis patients [Uso dell'ofloxacin nei pazienti con fibrosi cistica]. Minerva Pediatrica 1992;44(3):79‐86. - PubMed
    1. Romano L, Minicucci L, Spallone E, Girosi D, Campelli A, Fabbri A, et al. Role of home therapy with ofloxacin in patients with cystic fibrosis (CF) [Ruolo della terapia domiciliare conofloxacin in pazienti con fibrosi cistica]. Giornale italiano di chemioterapia 1991;38(1‐3):181‐3. - PubMed
Rubio 1987 {published data only}
    1. Rubio TT. Ciprofloxacin: comparative data in cystic fibrosis. American Journal of Medicine 1987;82(Suppl 4a):185‐8. - PubMed
Saiman 2003 {published data only}
    1. Nguyen D, Mayor‐Hamblett N, Marshall BC, Saiman L, Burns JL. Phenotypic characterization of Pseudomonas aeruginosa as a potential predictor of clinical response to azithromycin in CF patients [abstract]. Pediatric Pulmonology 2004;38(Suppl 27):286.
    1. Saiman L. What have we learned from further analysis of the U.S. macrolide trial? Subgroup analysis of azithromycin trial. Pediatric Pulmonology 2003;Suppl 25:165‐7.
    1. Saiman L, Marshall BC, Mayer‐Hamblett N, Burns JL, Quittner AL, Cibene DA, et al. Azithromycin in patients with cystic fibrosis chronically infected with Pseudomonas aeruginosa: a randomized controlled trial. JAMA 2003;290(13):1749‐56. - PubMed
    1. Saiman L, Mayer‐Hamblett N, Campbell P, Marshall BC, Macrolide Study Group. Heterogeneity of treatment response to azithromycin in patients with cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 2005;172(8):1008‐12. - PubMed
Scully 1987 {published data only}
    1. Scully BE, Nakatomi M, Ores C, Davidson S, Neu HC. Ciprofloxacin therapy in cystic fibrosis. American Journal of Medicine 1987;82(Suppl 4a):196‐201. - PubMed
Shapera 1981 {published data only}
    1. Shapera RM, Warwick WJ, Matsen JM. Clindamycin therapy of staphylococcal pulmonary infections in patients with cystic fibrosis. Journal of Pediatrics 1981;99(4):647‐50. - PubMed
Smith 1997 {published data only}
    1. Smith A, Weber A, Pandher R, Williams‐Warren J, Cohen ML, Ramsey B. Utilization of salivary concentrations of ciprofloxacin in subjects with cystic fibrosis. Infection 1997;25(2):106‐8. - PubMed
Sriram 2003 {published data only}
    1. Sriram S, Young J, Waterhouse JC, Bucknall CE, Stack BHR. The antiinflammatory effect of clarithromycin in CF [abstract]. Journal of Cystic Fibrosis 2003;2(Suppl 1):S52.
Strandvik 1989 {published data only}
    1. Christensson BA, Nilsson‐Ehle I, Ljungberg B, Lindblad A, Malmborg AS, Hjelte L, et al. Increased oral bioavailability of ciprofloxacin in cystic fibrosis patients. Antimicrobial Agents and Chemotherapy 1992;36(11):2512‐7. - PMC - PubMed
    1. Strandvik B, Hjelte L, Lindblad A, Ljungberg B, Malmborg AS, Nilsson‐Ehle I. Comparison of efficacy and tolerance of intravenously and orally administered ciprofloxacin in cystic fibrosis patients with acute exacerbations of lung infection. Scandinavian Journal of Infectious Diseases. Supplementum 1989;60:84‐8. - PubMed
Stutman 1987 {published data only}
    1. Shalit I, Stutman HR, Marks MI, Chartrand SA, Hilman BC. Randomized study of two dosage regimens of ciprofloxacin for treating chronic bronchopulmonary infection in patients with cystic fibrosis. American Journal of Medicine 1987;82(Suppl 4a):189‐95. - PubMed
    1. Stutman HR, Shalit I, Marks MI, Greenwood R, Chartrand SA, Hilman BC. Pharmacokinetics of two doses regimens of ciprofloxacin during a two‐week therapeutic trial in patients with cystic fibrosis. American Journal of Medicine 1987;82(Suppl 4a):142‐5. - PubMed
Treggiari 2011 {published data only}
    1. Anstead M, Heltshe SL, Khan U, Barbieri JT, Langkamp M, Doring G, et al. Pseudomonas aeruginosa serology and risk for re‐isolation in the EPIC trial. Journal of Cystic Fibrosis 2013;12(2):147‐53. [CENTRAL: 1089772; CFGD Register: PI202m; CRS: 5500135000000084; PUBMED: 22944725] - PMC - PubMed
    1. Anstead M, Lymp J, Khan U, Barbieri J, Langkamp M, Doring G, et al. Pseudomonas aeruginosa serology predicts response to treatment and re‐infection in the EPIC clinical study [abstract]. Pediatric Pulmonology 2011;46(S34):303, Abstract no: 254. [CFGD Register: PI202g]
    1. Anstead M, Saiman L, Mayer‐Hamblett N, Lands LC, Kloster M, Goss CH, et al. Pulmonary exacerbations in CF patients with early lung disease. Journal of Cystic Fibrosis 2014;13(1):74‐9. [CFGD Register: PI202l] - PubMed
    1. Hamblett NM, Retsch‐Bogart GZ, Treggiari M, Kronmal RA, Khan U, Williams J, et al. Safety and efficacy of anti‐pseudomonal therapy for early eradication of Pseudomonas aeruginosa: the EPIC study [abstract]. Pediatric Pulmonology 2009;44(S32):183. [CFGD CF Register: PI202b; MEDLINE: ]
    1. Hoffman LR, Ramsey BW, Kulasekara HD, Retsch‐Bogart GZ, Wolter DJ, Pope CE, et al. Pseudomonas aeruginosa (PA) phenotypes associated with persistent early infection in CF patients in the EPIC Clinical Trial [abstract]. Pediatric Pulmonology 2012;47(S35):317, Abstract no: 266. [CFGD Register: PI202j]
Vitti 1975 {published data only}
    1. Vitti TG, Berg TJ, Pagtakhan BS, Pagtakhan RD. The effect of pancreatic enzyme supplement on the intestinal absorption of ampicillin and cloxacillin in children with cystic fibrosis [abstract]. Proceedings of the 16th Annual Meeting Cystic Fibrosis Club Abstracts; 1975. 1975:56.
Weaver 1994 {published data only}
    1. Beardsmore CS, Thompson JR, Williams A, McArdle EK, Gregory GA, Weaver LT, et al. Pulmonary function in infants with cystic fibrosis: the effect of antibiotic treatment. Archives of Disease in Childhood 1994;71(2):133‐7. - PMC - PubMed
    1. Weaver LT, Green MR, Nicholson K, Heeley ME, Mills J, Kuzemko JA. Continuous prophylactic flucloxacillin improves outcome of infants with cystic fibrosis (CF) detected soon after birth [abstract]. Proceedings of 63rd Annual Meeting of the British Paediatric Association; Warwick, UK; 1991. 1991:24.
    1. Weaver LT, Green MR, Nicholson K, Mills J, Heeley ME, Kuzemko JA, et al. Prognosis in cystic fibrosis treated with continuous flucloxacillin from the neonatal period. Archives of Disease in Childhood 1994;70(2):84‐9. - PMC - PubMed
Wolter 2002 {published data only}
    1. Bell SC, Seeney S, Walmsley K, Wolter JM, Bowler SD, McCormack JG. Long term treatment with azithromycin results in reduced ex‐vivo inflammatory cytokine production in adults with cystic fibrosis [abstract]. Pediatric Pulmonology 2002;Suppl 24:289‐90.
    1. Bowler SD. Effect of long term treatment with azithromycin on disease parameters in cystic fibrosis. Japanese Journal of Antibiotics 2003;56(Suppl A):38. - PubMed
    1. Bowler SD, Masel PJ, Bell SC, Seeney SL, Wolter JM, McCormack JG. A prospective randomised trial of long term azithromycin (AZM) versus placebo in cystic fibrosis; impact on clinical, laboratory and quality of life (QOL) outcomes [abstract]. Pediatric Pulmonology. 2000; Vol. Suppl 20:280.
    1. Bowler SD, Seeney S, Walmsley K, Wolter JM, Bell SC, McCormack JG. Long‐term treatment with azithromycin results in reduced in vitro inflammatory cytokine production in adults with cystic fibrosis [abstract]. Respirology 2002;7(Suppl):A9.
    1. Seeney SL, Bowler SD, Wolter JM, Bell SC, Masel PJ, McCormack JG. A prospective randomised trial of long term azithromycin (AZM) versus placebo in cystic fibrosis (CF): impact on clinical, laboratory and quality of life (QOL) outcomes [abstract]. Internal Medicine Journal 2001;31(Suppl):A12.

References to studies awaiting assessment

Xu 2012 {published data only}
    1. Xu X, Abdalla T, Sabbatini G Roberts T, Bratcher P, Jackson PL, Blalock JE, et al. A randomized double blinded placebo controlled trial of doxycycline as an adjunctive therapy for the treatment of inpatient cystic fibrosis exacerbation [abstract]. Pediatric Pulmonology 2014;49 Suppl 38:312, Abstract no: 270. [CENTRAL: 1012523; CFGD Register: PI270b; CRS: 5500131000000174]
    1. Xu X, Sabbatini GM, Hathorne H, Clancy JP, Gaggar A. A randomized double blinded placebo control trial of doxycycline as an adjunctive anti‐inflammatory agent during CF exacerbation (DOXY) [abstract]. Pediatric Pulmonology 2012;47(S35):296, Abstract no: 209. [CENTRAL: 962120; CFGD Register: PI270a; CRS: 5500125000000029]

Additional references

Balaguer 2012
    1. Balaguer A, González de Dios J. Home versus hospital intravenous antibiotic therapy for cystic fibrosis. Cochrane Database of Systematic Reviews 2012, Issue 3. [DOI: 10.1002/14651858.CD001917.pub3] - DOI - PubMed
Ball 1986
    1. Ball P. Ciprofloxacin: an overview of adverse experiences. Journal of Antimicrobial Chemotherapy 1986;18(Suppl D):187‐93. - PubMed
Ball 1990
    1. Ball P. Emergent resistance to ciprofloxacin amongst Pseudomonas aeruginosa and Staphylococcus aureus: clinical significance and therapeutic approaches. Journal of Antimicrobial Chemotherapy 1990;26(Suppl F):165‐79. - PubMed
Burns 2001
    1. Burns JL, Gibson R, McNamara S, Yim D, Emerson J, Rosenfeld M, et al. Longitudinal assessment of Pseudomonas aeruginosa in young children with cystic fibrosis. Journal of Infectious Diseases 2001;183(3):444‐52. - PubMed
CF Trust 2004
    1. UK Cystic Fibrosis Trust Infection Control Group. Pseudomonas aeruginosa infection in people with cystic fibrosis: Suggestions for prevention and infection control. Report of the UK Cystic Fibrosis Infection Control Group. 2nd edition 2004.
CFF 2008
    1. Cystic Fibrosis Foundation. Patient Registry Report. www.cff.org/research/ClinicalResearch/PatientRegistryReport/ (accessed 26 August 2010).
Döring 2000
    1. Döring G, Conway SP, Heijerman HG, Hodson ME, Hoiby N, Smyth A, et al. Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus. European Respiratory Journal 2000;16(4):749‐67. - PubMed
Elbourne 2002
    1. Elbourne DR, Altman DG, Higgins JPT, Curtin F, Worthington HV, Vail A. Meta‐analyses involving cross‐over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140‐9. - PubMed
FitzSimmons 1993
    1. FitzSimmons SC. The changing epidemiology of cystic fibrosis. Journal of Pediatrics 1993;122(1):1‐9. - PubMed
FitzSimmons 1996
    1. FitzSimmons SC. The Cystic Fibrosis Foundation Patient Registry Report 1996. Pediatric Pulmonology 1996;21(Suppl):267‐75.
Gee 2000
    1. Gee L, Abbott J, Conway S, Etherington C, Webb A. Development of a disease specific health related quality of life measure for adults and adolescents with cystic fibrosis. Thorax 2000;55(11):946‐54. - PMC - PubMed
Gibson 2003
    1. Gibson RL, Burns JL, Ramsey BW. Pathophysiology and management of pulmonary infections in cystic fibrosis. American Journal of Respiratory and Critical Care Medicine 2003;168(8):918‐51. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration 2011. Available from www.cochrane‐handbook.org.
Kosorok 2001
    1. Kosorok MR, Zeng L, West SE, Rock MJ, Splaingard ML, Laxova A, et al. Acceleration of lung disease in children with cystic fibrosis after Pseudomonas aeruginosa acquisition. Pediatric Pulmonology 2001;32(4):277‐87. - PubMed
Langton Hewer 2014
    1. Langton Hewer SC, Smyth AR. Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis. Cochrane Database of Systematic Reviews 2014, Issue 11. [DOI: 10.1002/14651858.CD004197.pub4] - DOI - PubMed
Millar 2009
    1. Millar FA, Simmonds NJ, Hodson ME. Trends in pathogens colonising the respiratory tract of adult patients with cystic fibrosis, 1985‐2005. Journal of Cystic Fibrosis 2009;8(6):386‐91. - PubMed
Nixon 2001
    1. Nixon GM, Armstrong DS, Carzino R, Carlin JB, Olinsky A, Robertson CF, et al. Clinical outcome after early Pseudomonas aeruginosa infection in cystic fibrosis. Journal of Pediatrics 2001;138(5):699‐704. - PubMed
Parad 1999
    1. Parad RB, Gerard CJ, Zurakowski D, Nichols DP, Pier GB. Pulmonary outcome in cystic fibrosis is influenced primarily by mucoid Pseudomonas aeruginosa infection and immune status and only modestly by genotype. Infection & Immunity 1999;67(9):4744‐50. - PMC - PubMed
Patterson 1991
    1. Patterson DR. Quinolone toxicity: methods of assessment. American Journal of Medicine 1991;91(6A):35S‐37S. - PubMed
Quittner 2009
    1. Quittner AL, Modi AC, Wainwright C, Otto K, Kirihara J, Montgomery AB. Determination of the minimal clinically important difference scores for the Cystic Fibrosis Questionnaire‐Revised respiratory symptom scale in two populations of patients with cystic fibrosis and chronic Pseudomonas aeruginosa airway infection. Chest 2009;135(6):1610‐8. - PMC - PubMed
Rajan 2002
    1. Rajan S, Saiman L. Pulmonary infections in patients with cystic fibrosis. Seminars in Respiratory Infections 2002;17(1):47‐56. - PubMed
Ratjen 2006
    1. Ratjen F. Diagnosing and managing infection in CF. Paediatric Respiratory Review 2006;7(Suppl 1):S151‐3. - PubMed
Review Manager (RevMan) 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Rosenfeld 2001
    1. Rosenfeld M, Gibson RL, McNamara S, Emerson J, Burns JL, Castile R, et al. Early pulmonary infection, inflammation, and clinical outcomes in infants with cystic fibrosis. Pediatric Pulmonology 2001;32(5):356‐66. - PubMed
Schaad 2007
    1. Schaad UB. Will fluoroquinolones ever be recommended for common infections in children?. Pediatric Infectious Diseases Journal 2007;26(10):865‐7. - PubMed
Schaefer 1996
    1. Schaefer C, Amoura‐Elefant E, Vial T, Ornoy A, Garbis H, Robert E, et al. Pregnancy outcome after prenatal quinolone exposure. Evaluation of a case registry of the European Network of Teratology Information Services (ENTIS). European Journal of Obstetrics, Gynecology, and Reproductive Biology 1996;69(2):83‐9. - PubMed
Southern 2012
    1. Southern KW, Barker PM, Solis‐Moya A, Patel L. Macrolide antibiotics for cystic fibrosis. Cochrane Database of Systematic Reviews 2012, Issue 11. [DOI: 10.1002/14651858.CD002203.pub4] - DOI - PMC - PubMed
Wang 2001
    1. Wang S, Fitzsimmons S, O'Leary L, Rock M, Gwinn M, Khoury M. Early diagnosis of cystic fibrosis in the newborn period and risk of Pseudomonas aeruginosa in the first 10 years of life: a registry‐based longitudinal study. Pediatrics 2001;107(2):274‐9. - PubMed
West 2002
    1. West SE, Zeng L, Lee BL, Kosorok MR, Laxova A, Rock MJ, et al. Respiratory infections with Pseudomonas aeruginosa in children with cystic fibrosis: early detection by serology and assessment of risk factors. JAMA 2002;287(22):2958‐67. - PubMed

References to other published versions of this review

Remmington 2007
    1. Remmington T, Jahnke N, Harkensee C. Oral anti‐pseudomonal antibiotics for cystic fibrosis. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD005405.pub2] - DOI - PubMed
Remmington 2013
    1. Remmington T, Jahnke N, Harkensee C. Oral anti‐pseudomonal antibiotics for cystic fibrosis. Cochrane Database of Systematic Reviews 2013, Issue 10. [DOI: 10.1002/14651858.CD005405.pub3] - DOI - PubMed

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