TABLE 4.

Antimicrobial therapy for CF pulmonary exacerbations

SeverityColonizing oraganism/sDrug(s)RouteDoseComments
MildS. aureusDicloxacillinp.o.50-100 mg/kg/day q.i.d.Max 500 mg q.i.d.
Amoxicillinp.o.40 mg/kg/day t.i.d.Max 500 mg t.i.d.
Amoxicillin-clavulanatep.o.40 mg/kg/day t.i.d.Max 500 mg t.i.d.
Trimethoprim-sulfamethoxasolep.o.6-12 mg/kg/day b.i.d.pt > 2 mo
Cephalexinp.o.50-100 mg/kg/day t.i.d.Max 500 mg t.i.d.
S. aureus and H. influenzaeDrugs listed above except dicloxicillin
S. aureus and P. aeruginosaCiprofloxacinp.o.500-750 mg b.i.d.Patients > 18 yra
Add drugs listed under S. aureus, as Staphylococcus becomes rapidly resistant to ciprofloxacin
Consider adding tobramycin inhaled 150-300 mg b.i.d.
Consider adding colistinb inhaled 80-160 mg q.d-b.i.d.
P. aeruginosaCiprofloxacin plus inhaled tobramycin or colistin
Moderate and severeS. aureus and P. aeruginosaPiperacillin-tazobactamci.v.200-300 piperacillin mg/kg/day q.6hMax 24 g of piperacillin/day
Ticarcillin-clavulanatei.v.200-300 ticarcilling mg/kg/day q.6hMax 12 g of ticarcillin/day
Ceftazadimei.v.150-200 mg/kg/day q.8hMax 6 g/day
Aztreonami.v.150-200 mg/kg/day q.6-8hMax 8 g/day
Imipenemi.v.60-100 mg/kg/day q.6hMax 4 g/day
    Plus tobramycini.v.6-10 mg/kg/day q.8hpk 8-12 μg/ml
    Consider adding oxacillini.v.150-200 mg/kg/day q.4hMax 12 g/day
P. aeruginosaPiperacillini.v.200-300 piperacillin mg/kg/day q.6hMax 24 g of piperacillin/day
Ticarcillini.v.200-300 ticarcillin mg/kg/day q.6hMax 12 g of ticarcillin/day
    Or ceftazidime, aztreonam, imipenem as above
    Plus tobramycin
  • a Quinolones can be used in prepubertal children older than 5 years, although dosing standards have not been established.

  • b Colistin is used particularly for multidrug resistant organisms, or in patients who have demonstrated aminoglycoside toxicity.

  • c Piperacillin has a higher incidence of neutropenia and hypersensitivity reactions, but produces less platelet dysfunction than ticarcillin.