avibactam and Cystic-Fibrosis

In this clinician-therapeutic drug monitoring (TDM) consultant interaction, the authors describe the use of TDM in an 11-year-old female patient with cystic fibrosis receiving ceftazidime/avibactam and aztreonam for the treatment of persistent pulmonary exacerbations caused by Stenotrophomonas pneumonia. Serum drug concentrations at a steady state confirmed inadequate antimicrobial exposure, and continuous infusions of both ceftazidime/avibactam and aztreonam were required to optimize the percentage of time when free drug remained above the minimum inhibitory concentration (MIC), known as fT > MIC. After dose adjustment, this continuous infusion strategy resulted in 100% target attainment for fT > MIC. This case illustrates the importance of TDM, and the logistical issues encountered with the use of alternative dosing strategies in pediatric patients with CF.

Topics: Anti-Bacterial Agents; Azabicyclo Compounds; Aztreonam; Ceftazidime; Child; Cystic Fibrosis; Drug Combinations; Drug Monitoring; Female; Humans; Microbial Sensitivity Tests; Pneumonia, Bacterial; Stenotrophomonas maltophilia

In persons with cystic fibrosis (CF), airway infection with

Topics: Anti-Bacterial Agents; Azabicyclo Compounds; Burkholderia cepacia complex; Burkholderia gladioli; Burkholderia Infections; Cystic Fibrosis; Drug Resistance, Multiple, Bacterial; Drug Substitution; Humans; Kinetics; Microbial Sensitivity Tests; Piperacillin

Topics: Azabicyclo Compounds; Burkholderia cepacia complex; Burkholderia gladioli; Ceftazidime; Cephalosporins; Cystic Fibrosis; Drug Combinations; Humans; Tazobactam

The in vitro activity of anti-pseudomonal β-lactams in combination with avibactam was evaluated against 54 multidrug-resistant non-fermenting Gram-negative bacilli isolated from cystic fibrosis patients. Avibactam increased and/or restored the antibacterial activities of ceftazidime and aztreonam against Pseudomonas aeruginosa and Stenotrophomonas maltophilia, respectively. No β-lactam-avibactam combination was active against Achromobacter xylosoxidans.

Topics: Achromobacter denitrificans; Anti-Bacterial Agents; Azabicyclo Compounds; beta-Lactams; Cystic Fibrosis; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Stenotrophomonas maltophilia

Topics: Anti-Bacterial Agents; Azabicyclo Compounds; beta-Lactam Resistance; beta-Lactamase Inhibitors; Ceftazidime; Cystic Fibrosis; Humans; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Pseudomonas Infections