1 / 25

Managing CF patients with antibiotic hypersensitivity

Managing CF patients with antibiotic hypersensitivity. Oded Breuer, MD Pediatric Pulmonology and CF center Hadassah Hebrew University Medical Center. Drug Hypersensitivity. ADRs are known (or presumed) to be mediated by an immunologic mechanism.

baka
Download Presentation

Managing CF patients with antibiotic hypersensitivity

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Managing CF patients with antibiotic hypersensitivity Oded Breuer, MD Pediatric Pulmonology and CF centerHadassah Hebrew University Medical Center

  2. Drug Hypersensitivity ADRs are known (or presumed) to be mediated by an immunologic mechanism Solenski R. Med Clin N Am 90 (2006) 233–260

  3. Drug Hypersensitivity Non immediate >1hr Immediate <1hr Vs IgE Non IgE Vs Serious adverse drug reactions occur in 6.7% of hospitalized patients. and are one of the leading cause of death in these patients Castells et al, JACI 2008; 122: 574- 580

  4. prevalence of allergic reactions to antibiotics is high in adults with CF (up to 36%) • Risk factors: • Increasing age • cumulative courses • decreasing FEV1 Burrows JA, et al. Journal of Cystic Fibrosis 6 (2007) 297–303

  5. What is desensitization?

  6. First series of penicillin desensitizations Escalating oral doses 15 pregnant syphilis- infected women WendelGet al . N Engl J Med 1985; 312:1229– 1232.

  7. Cernadas JR, et al. Allergy 2010; 65: 1357–1366.

  8. A typical protocol Henry J. Legere et al, Journal of Cystic Fibrosis 8 (2009) 418–424

  9. Mechanism “Despite its clinical success, little is known about the mechanisms and molecular targets of drug desensitization” CernadasJR, et al. Allergy 2010; 65: 1357–1366.

  10. Adverse Events Castells et al, JACI 2008; 122: 574- 580

  11. Adverse Events Burrows et al. Antibiotic desensitization in adults with cystic fibrosisRespirology(2003) 8, 359–364

  12. Our experience

  13. Our patients

  14. Our protocol BorishL,et al. The Journal of allergy and clinical immunology. Sep 1987;80(3 Pt 1):314-319.

  15. For β Lactam Ab Time which drug concentration remains above the MIC Bacterial Killing Characteristics

  16. 200 mg/kg per day ceftazidimein three doses as a 30-minintravenous infusion “equally effective regimens for antipseudomonaltherapy in clinically stable patients with CF.” “Continuous infusion of ceftazidime was no different from that achieved with the conventional bolus infusion regimen” Vs continuous 23.5-h infusion of 100 mg/kg per day ceftazidime

  17. Bolus Vs. Continuous Bolus - 6 gr per day q8h 2 gr over 30 min Continuous - 6 gr per day 2 gr over 8 hr X 16 reduction in administered dose per time

  18. Our new protocol In high risk patients for severe allergic reaction Standard 8 step RDD Continuous infusion of a β lactam Ab

  19. Novel protocol for patient 1,4and8

  20. The new protocol - Results

  21. Conclusions 1. RDD protocols have allowed providing allergic CF patients with first-line therapy 2. Still, some CF patients cannot complete a full treatment course due to severe allergic reactions 3. Our novel protocol allows these patients to complete the desired treatment course and receive effective first line therapy

  22. Thank you

  23. Acknowledgments Hadassah Hebrew University Medical Center • The Pediatric Pulmonology and CF Center: EitanKerem, MD David Shoseyov, MD Malena Cohen-Cymberknoh, MD ShoshanaArmoni, RN

More Related