VanDevanter, D. R.West, N. E.Sanders, D. B.Skalland, M.Goss, C. H.Flume, P. A.Heltshe, S. L.2024-06-042024-06-042022VanDevanter DR, West NE, Sanders DB, et al. Antipseudomonal treatment decisions during CF exacerbation management. J Cyst Fibros. 2022;21(5):753-758. doi:10.1016/j.jcf.2022.04.006https://hdl.handle.net/1805/41190Background: Cystic fibrosis (CF) pulmonary exacerbation (PEx) treatment guidelines suggest that Pseudomonas aeruginosa (Pa) airway infection be treated with two antipseudomonal agents. Methods: We retrospectively studied treatment responses for STOP2 PEx treatment trial (NCT02781610) participants with a history of Pa infection. Mean lung function and symptom changes from intravenous (IV) antimicrobial treatment start to Visit 2 (7 to 10 days later) were compared between those receiving one, two, and three+ antipseudomonal classes before Visit 2 by ANCOVA. Odds of PEx retreatment with IV antimicrobials within 30 days and future IV-treated PEx hazard were modeled by logistic and Cox proportional hazards regression, respectively. Sensitivity analyses limited to the most common one-, two-, and three-class regimens, to only IV/oral antipseudomonal treatments, and with more stringent Pa infection definitions were conducted. Results: Among 751 participants, 50 (6.7%) were treated with one antipseudomonal class before Visit 2, while 552 (73.5%) and 149 (19.8%) were treated with two and with three+ classes, respectively. Females and participants with a negative Pa culture in the prior month were more likely to be treated with a single class. The most common single, double, and triple class regimens were beta-lactam (BL; n = 42), BL/aminoglycoside (AG; n = 459), and BL/AG/fluoroquinolone (FQ; n = 73). No lung function or symptom response, odds of retreatment, or future PEx hazard differences were observed by number of antipseudomonal classes administered in primary or sensitivity analyses. Conclusions: We were unable to identify additional benefit when multiple antipseudomonal classes are used to treat PEx in people with CF and Pa.en-USPublisher PolicyPulmonary exacerbationP. aeruginosaAntipseudomonal classesArticle