Prophylactic anti‐staphylococcal antibiotics for cystic fibrosis
Abstract
Background
Staphylococcus aureus causes pulmonary infection in young children with cystic fibrosis (CF). Prophylactic antibiotics are prescribed hoping to prevent such infection and lung damage. Antibiotics have adverse effects and long‐term use might lead to infection with Pseudomonas aeruginosa.
Objectives
To assess continuous oral antibiotic prophylaxis to prevent the acquisition of Staphylococcus aureus versus no prophylaxis in people with CF, we tested these hypotheses. Prophylaxis:
1. improves clinical status, lung function and survival;
2. causes adverse effects (eg diarrhoea, skin rash, candidiasis);
3. leads to fewer isolates of common pathogens from respiratory secretions;
4. leads to the emergence of antibiotic resistance and colonisation of the respiratory tract with Pseudomonas aeruginosa.
Search methods
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. Companies manufacturing anti‐staphylococcal antibiotics were contacted.
Most recent search of Register: 02 August 2012.
Selection criteria
Randomised trials of continuous oral prophylactic antibiotics (given for at least one year) compared to intermittent antibiotics given 'as required', in people with CF of any disease severity.
Data collection and analysis
The authors assessed studies for eligibility and methodological quality and extracted data.
Main results
We included four studies, totaling 401 randomised participants aged zero to seven years on enrolment. Fewer children receiving anti‐staphylococcal antibiotic prophylaxis had one or more isolates of Staphylococcus aureus. There was no significant difference between groups in infant or conventional lung function. We found no significant effect on nutrition, hospital admissions, additional courses of antibiotics or adverse effects. There was no significant difference in the number of isolates of Pseudomonas aeruginosa between groups, though there was a trend towards a lower cumulative isolation rate of Pseudomonas aeruginosa in the prophylaxis group at two and three years and towards a higher rate from four to six years. As the studies reviewed lasted six years or less, conclusions cannot be drawn about the long‐term effects of prophylaxis.
Authors' conclusions
Anti‐staphylococcal antibiotic prophylaxis leads to fewer children having isolates of Staphylococcus aureus, when commenced early in infancy and continued up to six years of age. The clinical importance of this finding is uncertain. Further research may establish whether the trend towards more children with CF with Pseudomonas aeruginosa, after four to six years of prophylaxis, is a chance finding and whether choice of antibiotic or duration of treatment might influence this.
PICOs
Plain language summary
Giving antibiotics regularly to people with cystic fibrosis to prevent infection with a germ called Staphylococcus aureus
Cystic fibrosis blocks the airways with mucus and causes frequent airway infections. These can lead to death from breathing failure. People with cystic fibrosis are sometimes given regular antibiotics to prevent infections from a germ called Staphylococcus aureus. However, antibiotics can also have adverse effects. The review includes four studies with 401 participants. All the studies were in children and were of variable quality. The review found some evidence that giving regular antibiotics to young children (continued up to six years of age) leads to less infection with Staphylococcus aureus. The studies showed no differences between giving regular antibiotics or not in other outcomes in the review. No study lasted longer than six years, so we can draw no conclusions about long‐term use. No study enrolled adults, so we can not comment on the use of these drugs in adults. Future research should look at antibiotic resistance patterns and patient survival.
