Outpatient Parenteral Antimicrobial Therapy May Contribute To Better Quality of Life For Cystic Fibrosis Patients

Outpatient Parenteral Antimicrobial Therapy May Contribute To Better Quality of Life For Cystic Fibrosis Patients

A new study entitled “Outpatient parenteral antimicrobial therapy (OPAT) in patients with cystic fibrosis” was published this July in the BMC Infectious Diseases. The study revealed that OPAT may contribute to better quality of life for CF patients who have to manage lung infections.

Cystic fibrosis (CF) is a hereditary, fatal disease that affects the lungs and digestive system. The disease is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR, 7q31). The airways of CF patients are frequently colonized by pathogens that cannot be successfully cleared due to the ion channel mutations and the resulting viscous secretions. This leads to chronic pathogen colonization and inflammation in airway, leading to progressive pulmonary destruction, which is the main cause of higher morbidity and mortality in CF. There is no cure for the disease and the standard therapy mainly control symptoms, reduce the decline in lung function over time, and increase life expectancy. However, new therapies such as Kalydeco and Orkambi are beginning to address the underlying cause of the disease as well.

In cystic fibrosis, antibiotic therapy is administered mainly through three routes, intravenous, oral and inhaled aerosol. The intravenous route is given to patients with bacteria susceptible to antibiotics and who have symptoms involving considerable pulmonary exacerbation. Outpatient parenteral antimicrobial therapy (OPAT) is a good alternative for CF patients to have quality of life with minimal disturbance while performing antibiotic therapy. Moreover, OPAT reduces the risk of transmission of bacteria between CF patients and reduces isolation procedures at the hospital. However, this route of antibiotic administration is a challenge for the patient since if the precise amount of antibiotics is not delivered at the right time, this may lead to failure or prolonged therapy.

The research team did a retrospective review on 167 CF patients followed at the Cystic Fibrosis Center at Aarhus University Hospital, Denmark. They identified patients who received regular OPAT with peripheral or central intravenous lines and estimated the frequency of the complications observed during and after OPAT by both route lines. The choice of type of line insertion depends if the patient wants a permanent or duration of antibiotic treatment. All the interviewed patients preferred having chosen OPAT and believed it could be successful in helping them avoid confinement in the hospital for long periods of intravenous antibiotic treatment. The patients experienced some problems with OPAT, however, and researchers noted that it is crucial to explore a better understanding of the problems associated with the different type of line insertions associated with OPAT to further improve this alternative route of treatment.

This study also had some limitations such as being a retrospective study performed during a  limited period of time, with a small sample size of 60 patients and from just one of the two CF centers in Denmark. However, the findings are bound to help physicians and specialists customize treatment for CF patients in a way that maximizes their quality of life.

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