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Use of piperacillin, a semisynthetic penicillin, in the therapy of acute exacerbations of pulmonary disease in patients with cystic fibrosis

1980; Elsevier BV; Volume: 97; Issue: 1 Linguagem: Inglês

10.1016/s0022-3476(80)80157-0

1097-6833

Prince Alice S., Harold C. Neu,

Antibiotic Resistance in Bacteria

OUR ENTHUSIASM for this manuscript and the study which it reflects is in large measure related to the important question raised by Dr. Beaudry and his colleagues. Two reviewers developed significantly different degrees of enthusiasm for the study, although each had virtually the same underlying reservations. In a critique of the study, one of the reviewers wrote as follows: Conclusions should be based on studies which meet the following criteria: (1) They should be well controlled and double blind; (2) they should compare the effects of drugs on three separate groups of patients who appear to be infected predominantly with (a) Pseudomonas.aeruginosa, (b) Pseudomonas aeruginosa and Staphylococcus attreus, and (c) Staphylococcus attreus, (3) the choice of patients should be restricted to those with mild or moderate disease with acute exacerbations in whom the effects of antibiotic regimens are most likely to be easily and reliably assessed; and (4) a large number of patients should be studied so that reliable statistical inferences can be drawn. Meanwhile, the other reviewer indicated the following: manuscript does not answer all the questions that could or should be resolved; however, it does give us a start. It is high time to address ourselves to the wisdom of a therapeutic approach that has never been adequately documented. The presence of pseudomonas or staphylococci, or both, in sputum cultures has never excited me very much. These patients have the same organisms when they are sick or not so sick (they are never well!). Treatment of these patients has been more of a ritual rather than a scientific approach. Authors, reviewers, and editors will all agree that the paper is not one which will allow the practicing physician to know precisely what to do. In our view, recommendations in reference to therapy (particularly antimicrobial therapy) too often are advanced ex cathedra. A wellconceived and well-executed study, done prospectively along the lines advocated by all and possibly (ideally?) involving several centers, would be most likely to provide clear answers. The parallel between the kind of study proposed and those which are initiated in an effort to advance therapy for children with leukemia is striking. Conversely, and sadly, the present state of affairs relative to the treatment of cystic fibrosis is often, a matter of opinion rather than fact. We hope that this manuscript will serve as a stimulus to the kind of study which is advocated by all concerned. R.E.M.