Comparative Efficacy and Safety of 4 Randomized Regimens to Treat Early Pseudomonas aeruginosa Infection in Children With Cystic Fibrosis ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Treggiari, M. M., Retsch-Bogart, G., Mayer-Hamblett, N., Khan, U., Kulich, M., Kronmal, R., Williams, J., Hiatt, P., Gibson, R. L., Spencer, T., Orenstein, D., Chatfield, B. A., Froh, D. K., Burns, J. L., Rosenfeld, M., Ramsey, B. W. 2011; 165 (9): 847-856


To investigate the efficacy and safety of 4 antipseudomonal treatments in children with cystic fibrosis with recently acquired Pseudomonas aeruginosa infection.Randomized controlled trial.Multicenter trial in the United States.Three hundred four children with cystic fibrosis aged 1 to 12 years within 6 months of P aeruginosa detection.Participants were randomized to 1 of 4 antibiotic regimens for 18 months (six 12-week quarters) between December 2004 and June 2009. Participants randomized to cycled therapy received tobramycin inhalation solution (300 mg twice a day) for 28 days, with oral ciprofloxacin (15-20 mg/kg twice a day) or oral placebo for 14 days every quarter, while participants randomized to culture-based therapy received the same treatments only during quarters with positive P aeruginosa cultures.The primary end points were time to pulmonary exacerbation requiring intravenous antibiotics and proportion of P aeruginosa -positive cultures.The intention-to-treat analysis included 304 participants. There was no interaction between treatments. There were no statistically significant differences in exacerbation rates between cycled and culture-based groups (hazard ratio, 0.95; 95% confidence interval [CI], 0.54-1.66) or ciprofloxacin and placebo (hazard ratio, 1.45; 95% CI, 0.82-2.54). The odds ratios of P aeruginosa- positive culture comparing the cycled vs culture-based group were 0.78 (95% CI, 0.49-1.23) and 1.10 (95% CI, 0.71-1.71) comparing ciprofloxacin vs placebo. Adverse events were similar across groups.No difference in the rate of exacerbation or prevalence of P aeruginosa positivity was detected between cycled and culture-based therapies. Adding ciprofloxacin produced no Identifier: NCT00097773.

View details for Web of Science ID 000294537100012

View details for PubMedID 21893650