Antimicrobial Stewardship in the Treatment of Infections Among Patients With Cystic Fibrosis

Purpose of Review To describe potential antimicrobial stewardship program strategies to enhance the optimization of antimicrobial therapy for patients with cystic fibrosis (CF). Recent Findings Cystic fibrosis is a complex medical condition known for its frequent pulmonary exacerbations attributed to microorganisms which are treated with antimicrobials administered by various routes. Due to exposure to antimicrobials from an early age, both as eradication regimens and for chronic colonization, this patient population often has drug-resistant organisms colonizing their respiratory tract. With CF patients surviving well into adulthood, preservation of antimicrobials is more essential now than ever. Antimicrobial stewardship programs have been shown to optimize antimicrobial use in the hospital and outpatient setting, but interventions applied to CF patients are not as well documented. For hospitalized patients, stewardship programs develop antibiotic dosing and monitoring guidelines and treatment algorithms. In addition to these approaches, the CF population may benefit from review of different routes or methods of administration of antimicrobials to optimize pharmacokinetics and pharmacodynamics. These include inhaled antibiotics and prolonged infusions. In the CF population that is exposed to frequent courses of antimicrobials, we propose that collaboration with a stewardship program to engage in optimization of antimicrobial administration would benefit both patients and health care providers. Moreover, given that the majority of antibiotics that CF patients receive are prescribed and administered in the outpatient setting, antimicrobial stewardship to promote judicious use of antibiotics in the outpatient setting should be explored.