Elsevier

Archives de Pédiatrie

Volume 7, Issue 6, June 2000, Pages 645-656
Archives de Pédiatrie

Mise au point
L'antibiothérapie dans la mucoviscidose: II. Stratégie antibiotiqueAntibiotic therapy in cystic fibrosis

https://doi.org/10.1016/S0929-693X(00)80134-7Get rights and content

Résumé

L'antibiothérapie est un aspect fondamental de la prise en charge des patients atteints de mucoviscidose. Elle participe à l'amélioration de l'état nutritionnel et respiratoire et, à long terme, à l'augmentation de la survie. Le choix des antibiotiques se fonde sur l'analyse quantitative et qualitative de la flore d'expectoration, les phénotypes de résistance des germes retrouvés en culture et la gravité de l'infection. Les infections à Haemophilus influenzae sont traitées per os par l'association amoxicilline-acide clavulanique ou une céphalosporine orale. Les infections à Staphylococcus aureus restent le plus souvent sensibles aux antibiotiques usuels ; dans le cas d'une souche résistante à la méthicilline, une bithérapie orale ou un traitement parentéral est préconisé. Le traitement de l'infection à Pseudomonas aeruginosa est différent selon qu'il s'agit d'une primocolonisation ou d'une infection chronique: dans le premier cas, une bithérapie parentérale (β-lactamine-aminoside), prolongée par une antibiothérapie par voie inhalée peut permettre d'éradiquer le germe et d'éviter le passage à l'infection chronique ; dans le second cas, les périodes d'exacerbation de l'infection chronique se traitent par une bi-antibiothérapie parentérale associant une β-lactamine ou une quinolone et un aminoside pendant 15 jours à trois semaines. Ceci conduit à une amélioration de l'état nutritionnel et respiratoire et, à long terme, à une augmentation de la survie. La pratique des aérosols d'antibiotiques entre les cures permet de diminuer le nombre des exacerbations infectieuses. Lantibiothérapie au long cours doit être surveillée étroitement, compte tenu de problèmes d'induction de résistance, du risque de néphrotoxicité et d'ototoxicité des aminosides et des allergies aux β-lactamines.

Summary

Antibiotherapy is one of the main treatments of cystic fibrosis, contributing to a better nutritional and respiratory status and a prolonged survival. The choice of antibiotics depends on quantitative and qualitative analysis of sputum, bacteria resistance phenotypes and severity of infection. Haemophilus influenzae infection can be treated orally with the association of amoxicillin-clavulanic acid or a cephalosporin. Staphylococcus aureus generally remains sensitive to usual antibiotics; in case of a methicillin-resistant strain, an oral bitherapy or a parenteral cure can be proposed. Treatment of Pseudomonas aeruginosa is different in case of first colonization or chronic infection: in first colonization, parenteral antibiotherapy (β-lactams-aminoglycosids) followed by inhaled antibiotherapy may eradicate the bacteria; in chronic infections, exacerbations require parenteral biantibiotherapy (β-lactams or quinolons and aminoglycosids) for 15 to 21 days, inhaled antibiotics between the cures being useful to decrease the number of exacerbation. A careful monitoring of antibiotherapy is necessary because of possible induction of bacterial resistance, nephrotoxicity and ototoxicity of aminosids and allergy to β-lactams.

Références (103)

  • DavidTJ et al.

    Continuous infusion of ceftazidime in cystic fibrosis

    Lancet

    (1989)
  • KuzemkoJ et al.

    Continuous infusion of ceftazidime in cystic fibrosis [Letter]

    Lancet

    (1989)
  • LipumaJJ

    Burkholderia cepacia. Management issues and new insights

    Clin Chest Med

    (1998)
  • LittlewoodJM et al.

    Nebulised colomycin for early Pseudomonas colonisation in cystic fibrosis by early treatment [Letter]

    Lancet

    (1985)
  • ValeriusN et al.

    Prevention of chronic Pseudomonas aeruginosa colonisation in cystic fibrosis by early treatment

    Lancet

    (1991)
  • SmithA et al.

    Sputum changes associated with therapy for endobronchial exacerbation in cystic fibrosis

    J Pediatr

    (1988)
  • ClaytonRG et al.

    Pulmonary function in hospitalized infants and toddlers with cystic fibrosis

    J Pediatr

    (1998)
  • HodsonME et al.

    Aerosol carbenicillin and gentamycin treatment of Pseudomonas aeruginosa infection in patients with cystic fibrosis

    Lancet

    (1981)
  • RamseyBW

    Drug therapy. Managment of pulmonary disease in patients with cystic fibrosis

    N Engl J Med

    (1996)
  • FoucaudP et al.

    Infection à pyocyanique dans la mucoviscidose. Stratégies thérapeuti-ques

    Presse Méd

    (1990)
  • LenoirG

    Pseudomonas aeruginosa et mucoviscidose

    Rev Pneumol Clin

    (1995)
  • BurnsJL et al.

    Microbiology of sputum from patients at cystic fibrosis centers in the United States

    Clin Infect Dis

    (1998)
  • LeBourgeois M et al.

    Bases bactériologiques et traitements antibiotiques au cours de la mucoviscidose

  • ChabanonG et al.

    Aspects microbiologiques des infections au cours de la mucovis-cidose

    Med Therap

    (1997)
  • SaimanL et al.

    What is the association between CF pathogens and morbidity and mortality?

  • WagenerJ et al.

    New cases of Pseudomonas aeruginosa: risk factors and outcomes

    Pediatr Pulmonol

    (1998)
  • PierG et al.

    Cystic fibrosis tranmembrane conductance regulator is an epithelial cell receptor for clearance of Pseudomonas aeruginosa from the lung

  • HiattPW et al.

    Effects of viral lower respiratory tract infection on lung function in infants with cystic fibrosis

    Pediatrics

    (1999)
  • BalesR et al.

    Innate immune system in CF lung disease

    J Clin Invest

    (1999)
  • WineJJ

    Genesis of Cystic Fibrosis lung disease

    J Clin Invest

    (1999)
  • SimmondsEJ et al.

    Pseudomonas cepacia: a new pathogen in patients with cystic fibrosis referred to a large centre in the United Kingdom

    Arch Dis Child

    (1990)
  • MahenthiralingamE et al.

    Molecular speciation of Burkholderia cepacia complex strains recovered from patients with cystic fibrosis

    Pediatr Pulmonol

    (1998)
  • BurnsJL et al.

    Molecular epidemiology of Stenotrophomonas and Alcaligenes [Abstract]

  • BangeFC et al.

    Recovery of mycobacteria from patients with cystic fibrosis

    J Clin Microb

    (1999)
  • BellonG et al.

    Antibiothérapie dans la mucoviscidose: incertitudes et réalités

    Rev Mal Resp

    (1990)
  • MendelmanPM et al.

    Aminoglycoside penetration inactivation and efficacy in cystic fibrosis sputum

    Am Rev Respir Dis

    (1985)
  • GaillardJL et al.

    Correlation between activity of betalactam agents in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis

    Eur J Clin Microbiol Infect Dis

    (1995)
  • PereaEJ et al.

    Interaction of aminoglycosides, cephalosporins against pseudomonas aeruginosa. Correlation between interaction index and killing curve

    J Antimicrob Chemother

    (1988)
  • MarksMI

    Antibiotics are not always useful in the treatment of pulmonary infections in patients with cystic fibrosis. A point of view

    Pediatr Pulmonol

    (1996)
  • WolterJM et al.

    Are antipseudomonal antibiotics really beneficial in acute respiratory exacerbations of cystic fibrosis?

    Aust N Z J Med

    (1999)
  • DentonM et al.

    Antimicrobial treatment of pulmonary colonization and infection by Pseudomonas aeruginosa in cystic fibrosis patients

    J Antimicrob Chemother

    (1997)
  • BingenE

    Antibiotic choice for Pseudomonas pulmonary infections in children with cystic fibrosis [Letter]

    Pediatr Pulmonol

    (1997)
  • IaconisJP et al.

    Comparison of antibacterial activities of meropenem and six other antimicrobials against Pseudomonas aeruginosa isolates from North american studies and clinical trials

    Clin Inf Dis

    (1997)
  • LevyJ et al.

    Comparative study of the antibacterial activity of amikacin and tobramycin during Pseudomonas aeruginosa infection in patients with cystic fibrosis

    J Antimicrob Chemother

    (1982)
  • ConwaySP et al.

    Intravenous colistin sulphomethate in acute respiratory exacerbations in adult patients with cystic fibrosis

    Thorax

    (1997)
  • GhaniM et al.

    Ceftazidime, gentamicin rifampicin, in combination, kill biofims of mucoid Pseudomonas aeruginosa

    Can J Microbiol

    (1997)
  • KoyabashiH et al.

    Study on azithromycin in treatment of diffuse panbronchilitis

    J Jpn Assoc Infect Dis

    (1995)
  • Guillot M, Eckart P, Desrosieres H, Brouard J. Macrolides et infection à pyocyanique Ann Pédiatr [à...
  • KitAA et al.

    Suppression of virulence factors of Pseudomonas aeruginosa by erithromycin

    Antimicrob Chemother

    (1991)
  • HosoyamaT et al.

    Inhibitory effect of antimicrobial agents on alginate production in Pseudomonas aeruginosa

    J Antibiotics

    (1999)
  • Cited by (7)

    • Cystic fibrosis and bacterial infection

      2007, Revue Francophone des Laboratoires
    • Antibiotics allergy in cystic fibrosis

      2002, Revue Francaise d'Allergologie et d'Immunologie Clinique
    • Bronchopulmonary infection in cystic fibrosis

      2005, Medecine Therapeutique Pediatrie
    View all citing articles on Scopus
    View full text