Summary
Data from the literature and the authors' experiences were used to review aspects of antibiotic therapy of patients with cystic fibrosis; attention was paid toin vitro antimicrobial susceptibility tests and assessment of therapy directed against mucoidPseudomonas aeruginosa. The heterogeneity ofP. aeruginosa within single sputa with respect to antibiotic susceptibility is stressed. Quantitative viable counts of bacteria based on an analysis of homogenised sputum is recommended. The mode ofin vivo growth of mucoidP. aeruginosa is discussed to explain the survival of hypersusceptibleP. aeruginosa in vivo, and the clinical benefit observed in the absence of a significant reduction of the pathogen. The value of ceftazidime in the treatment of exacerbations due toHaemophilus influenzae is emphasised. The social benefits from oral administration of ciprofloxacin also emphasises that the patient's quality of life must also be considered.
Zusammenfassung
In einer Übersicht werden Daten aus der Literatur und eigene Erfahrungen in der Antibiotikatherapie bei Patienten mit zystischer Fibrose dargestellt. DieIn vitro-Testung und klinische Beurteilung der Therapie von Infektionen durch mukoide Stämme vonPseudomonas aeruginosa finden besondere Beachtung.P. aeruginosa-Isolate aus einer einzigen Sputumprobe weisen im Hinblick auf ihre Antibiotikaempfindlichkeit eine bemerkenswerte Heterogenität auf. Keimzahlenbestimmungen sollten an homogenisierten Sputumproben vorgenommen werden. DasIn vivo-Wachstumsverhalten mukoiderP. aeruginosa-Stämme gibt Aufschluß über die Beobachtung, daß hochempfindliche Stämme vonP. aeruginosa in vivo überleben. Auf das Phänomen der klinischen Besserung ohne signifikante Erregerreduktion wird eingegangen. Hervorgehoben wird der Wert von Ceftazidim in der Therapie akuter Exazerbationen durchHaemophilus influenzae. Der soziale Gewinn einer oralen Therapie mit Ciprofloxacin weist auf die Bedeutung der Lebensqualität für den Patienten hin.
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Govan, J.R.W., Doherty, C. & Glass, S. Rational parameters for antibiotic therapy in patients with cystic fibrosis. Infection 15, 300–307 (1987). https://doi.org/10.1007/BF01644142
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DOI: https://doi.org/10.1007/BF01644142