Duration of intravenous antibiotic treatment for acute exacerbations of cystic fibrosis: A systematic review

• Published in: Journal of cystic fibrosis Vol. 21; no. 4; pp. 562 - 573
• Main Authors: Nicholson, Trevor T, Smith, Aisling, McKone, Edward F, Gallagher, Charles G
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.07.2022
• Subjects: acute exacerbations; Antibiotic; Cystic fibrosis; Duration of treatment; CRP; CFF; OR; acute exacerbations; STOP; Cystic fibrosis; PRISMA; NRS; TTNE; ESCF; Duration of treatment; Antibiotic; ppFEV1; RE; AECF; WBC; FEV1; MOOSE; FE
• ISSN: 1569-1993; 1873-5010
• DOI: 10.1016/j.jcf.2021.08.017

•Extensive systematic review of literature on acute exacerbations of cystic fibrosis, where only studies with pre-defined durations of treatment were included.•Studies were categorized according to their duration of treatment, of 10-12 days and 13-15 days. No significant differences in change in FEV1 were observed based on duration of treatment.•Treatment setting may affect outcome. When the entire treatment course was as an inpatient, no significant difference in change in FEV1 was observed. However, where some of the total treatment duration was administered as an inpatient, studies with longer treatment durations had a significantly greater change in FEV1 compared with shorter durations. Acute exacerbations of Cystic Fibrosis (AECF) are associated with significant morbidity. Recommendations are to treat for 2-3 weeks despite limited data. Spirometry is a measure of clinical response yet appears to plateau at 7-10 days. While durations <9 days have been associated with poorer outcomes, a duration of 10 days may be as effective as 14 days, potentially conferring advantages in terms of cost and adverse events. A 2019 Cochrane review by Abbott et al. did not identify any randomised controlled trials (RCT) comparing durations of treatment. Utilising data from non-randomised studies (NRS), we report a systematic review of intravenous antibiotic treatment, exploring changes in FEV1 (Forced Expiratory Volume in 1 second), CRP (C-reactive protein) and peripheral WBC (white blood cell) count in studies with different treatment durations. Systematic review of published literature following a search of MEDLINE, Embase, CINAHL and the Cochrane Clinical Trials register. Guidelines from the Preferred Reporting items for Systematic reviews and Meta-Analysis (PRISMA) and reporting Meta-analysis of Observational studies (MOOSE) statement were followed. No randomised controlled trials were identified that specifically examined duration of treatment during AECF. This study included all relevant RCTs and also NRS, grouping according to study characteristics, such as length of treatment, location, year, and also characteristics of the patient population. 52 studies, comprising 79 subgroups, and 1,597 patients, were identified. Mean change (95%CI) in ppFEV1 was 10.13 (9.21-11.05). There was no significant difference in change in ppFEV1 for studies treating for 10-12 days; 8.85 (7.47-10.23), vs 13-15 days; 10.68 (9.53-11.82). Similar changes in CRP and WBC were seen irrespective of treatment duration. This systematic review provides evidence that shorter durations of treatment may be associated with similar changes in FEV1, CRP and WBC compared with longer durations.