CF- Acute Pulmonary Exacerbations Flashcards
Symptoms of APE in CF
cough, increased sputum production, SOB, chest pain, loss of appetite, weight loss, lung function decline
Pulmonary management in APE
Intensify treatment of pulmonary obsttruction; increase frequency of hypertonic saline, dornase alfa, albuterol inhaler, etc.
Pathogen most common in early childhood-adolescence
S. aureus
MRSA incidence
Less common in early childhood but increases in adolescence and stays stable at 30% incidence in early adulthood
Pseudomonas incidence
3rd most common pathogen in early childhood, but increases and passes H. influenzae and becomes the most common pathogen starting in the age 25-34 group
ABX selection when there’s no culture data
Empiric selection based on population data
ABX selection where there is culture data
ABX selection can be individualized on historical culture history
ABX dosing when the patient hasn’t been given an ABX before
Dosing based on population PK data
ABX dosing when the patient has been given ABX before
individualized based on patient-specific historical PK data
ABX treatment regimens: history of MSSA but no pseudomonas
antistaphylococcal PCN or cephalosporin
ABX treatment regimen: history of MSSA and pseudomonas
cefepime, aminoglycoside
ABX treatment regimen: history of MRSA but no pseudomonas
Vanco OR linezolid
ABX treatment regimen: history of MRSA and pseudomonas
Vanco OR linezolid plus aminoglycoside and a beta-lactam (ceftazadime)
ABX treatment regimen: B. cepacia and/or S. maltophilla
Combo therapy with 2-3 drugs, guided by C+S data
Duration of ABX treatment
> 14-21 days, but if no improvement in 5-7 days, re-culture and/or adjust the ABX
Therapy can be completed at home with a PICC line or port ot PO step-down therapy
