Browsing by Subject "Cystic Fibrosis (CF)"

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    Oral antibiotic prescribing patterns for treatment of pulmonary exacerbations in two large pediatric CF centers
    (Wiley, 2020-09-24) Hoppe, Jordana E.; Hinds, Daniel M.; Colborg, Adrianne; Wagner, Brandie D.; Morgan, Wayne J.; Rosenfeld, Margaret; Zemanick, Edith T.; Sanders, Don B.; Pediatrics, School of Medicine
    Introduction: Oral antibiotics are frequently prescribed for outpatient pulmonary exacerbations (PEx) in children with cystic fibrosis (CF). This study aimed to characterize oral antibiotic use for PEx and treatment outcomes at two large US CF centers. Methods: Retrospective, descriptive study of oral antibiotic prescribing practices among children with CF ages 6–17 years over 1 year. The care setting for antibiotic initiation (clinic or phone encounter) was determined and outcomes were compared. Results: A total of 763 oral antibiotic courses were prescribed to 312 patients aged 6–17 years (77% of 403 eligible patients) with a median of two courses per year (range: 1–10). Fifty‐eight percent of prescriptions were provided over the phone. Penicillin was the most commonly prescribed antibiotic class (36% of prescriptions) but differences in antibiotic class prescriptions were noted between the two centers. Hospitalizations occurred within 3 months following 19% of oral antibiotic courses. Forced expiratory volume in 1 s (FEV1) recovered to within 90% of prior baseline within 6 months in 87% of encounters; the mean (SD) % recovery was 99.6% (12.1%) of baseline. Outcomes did not differ between phone and clinic prescriptions. Conclusions: Phone prescriptions, commonly excluded in studies of PEx, made up more than half of all oral antibiotic courses. Heterogeneity in prescribing patterns was observed between the two centers. Most patients had improvement in FEV1 returning to near their prior baseline, but hospitalizations occurred in one‐fifth following oral antibiotic treatment. Efforts to optimize PEx treatment must consider care that occurs over the phone; this is particularly important as the use of telemedicine increases.
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    The Regulatory Protein AlgR Influences Pseudomonas aeruginosa Pathogenesis on Airway Cells
    (Office of the Vice Chancellor for Research, 2013-04-05) Chakravarty, Shubham; Anderson, Gregory G.
    One of the primary causes of high mortality in patients with Cystic Fibrosis (CF) is lung infection caused by the Gram-negative bacterium Pseudomonas aeruginosa. In the lungs of such patients, this bacterium forms lifelong infections, characterized by biofilm formation. Our goal is to identify factors that influence P. aeruginosa biofilm formation in the CF airways. Using a novel model of biofilm formation on cultured human CF airway cells, we found that mutation of the gene algR resulted in significant reduction in the ability to form biofilms as well as adhere to CF airway cells. When algR gene activity was restored in these deletion mutant strains, by an algR complementation plasmid, adherence improved to a level similar to that of the wild type P. aeruginosa strain, and biofilm production was also restored significantly. Additionally, e observed the effects of AlgR on transcription of the Type III Secretion System (T3SS), and found that AlgR might be influence regulation of T3SS activity through the magnesium transporter protein MgtE. Altogether, our results point to a role for AlgR in biofilm formation on CF airway cells through modulation of T3SS as well as adherence. Through this and additional studies, such as investigation of cross-talk between AlgR and other genes such as MgtE, which is a putative virulence modulator in P. aeruginosa, we aim to get a more lucid understanding of the molecular mechanisms responsible for persistence of lifelong P. aeruginosa biofilms in lungs of CF patients.