Patient Encounter Part 3

At Jessica's follow-up appointment 1 month later, her weight is up to 8.8 kg. Her mother reports that she seems to have caught a cold and has been coughing quite a bit of late and has not been eating as well as usual. In clinic, the following vitals are noted: respiratory rate 40/min, temperature 38.3°C (100.9°F), and oxygen saturation 92%. The throat culture from her previous visit was positive for S. aureus (sensitive to cefazolin, nafcillin, trimethoprim-sulfamethoxazole, clindamycin, vancomycin, doxycycline, and linezolid; resistant to erythromycin) and P. aeruginosa (sensitive to ceftazidime, cefepime, piperacillin, aztreonam, meropenem, ciprofloxacin, tobramy-cin, and amikacin; resistant to gentamicin). She has no drug allergies.

What antibiotic(s) and dose(s) would you recommend for outpatient therapy? What antibiotic(s) and dose(s) would you recommend for inpatient therapy? Develop a monitoring plan to assess antibiotic response.

Antiresorptive agents (oral or IV bisphosphonates) may be used to treat adult CF patients with osteoporosis. Remaining upright each day for 30 minutes after dosing may be difficult for patients needing to perform airway clearance therapy, so products offering less frequent dosing should be considered. Gastroesophageal reflux or cirrhosis-associated esophageal varices may also complicate therapy and increase the risk of erosive esophagitis. Pamidronate 30 mg IV every 3 months has increased bone mineral density in adult CF patients, and studies using IV bisphosphonates in

children with CF are underway. Androgen replacement in male CF patients with documented hypogonadism may also benefit bone health but should be decided on an individual basis.1 ,29

Short courses of nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to treat CF-related arthritis and hypertrophic pulmonary osteoarthropathy.5 The impact on neutrophil recruitment in the lung with long-term NSAID therapy at lower analgesic doses is unknown.

Future Therapeutic Directions

Development of new therapies has extended the CF lifespan over the past several decades. Since the discovery of the CF gene and the CFTR protein defect, research has focused on gene therapy to restore normal CFTR function through DNA transfer. Pharmacologic approaches are being investigated to correct dysfunctional CFTR by suppressing premature stop codons in the CFTR gene and to activate alternative chloride channels, effectively bypassing dysfunctional CFTR. Additional research is being conducted with anti-inflammatory therapies, antipseudomonal vaccines, and development of exogenous cationic antimicrobial peptides to mimic those found naturally in the lung.1 Development of more effective systemic and inhaled antibiotic agents (such as tobramycin powder for inhalation, aztreonam lysine, and amikacin) continues to be a major focus as well.

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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