RESUMO
BACKGROUND: Chronic infection with Burkholderia cepacia complex (BCC) has a detrimental effect on morbidity and mortality for patients with cystic fibrosis (CF). It is therefore logical to attempt to eradicate new isolates however there is a paucity of information to guide treatment. We report the successful eradication of new isolates of BCC in two children with CF. CASE PRESENTATION: Burkholderia cepacia was successfully eradicated in a 14 year old boy with CF and Burkholderia gladioli was successfully eradicated in a six year old girl with CF. In both children two weeks of intravenous (IV) tobramycin, ceftazidime and temocillin were used followed by three months of inhaled tobramycin. Bronchoalveolar lavage samples taken during flexible bronchoscopy were used prior to treatment to exclude spontaneous clearance as well as after treatment to confirm eradication. CONCLUSIONS: New isolates of BCC can be successfully eradicated in children with CF. More research is urgently required in this area to identify the best treatment regimen for BCC eradication.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Burkholderia/tratamento farmacológico , Complexo Burkholderia cepacia/efeitos dos fármacos , Ceftazidima/uso terapêutico , Fibrose Cística/complicações , Penicilinas/uso terapêutico , Tobramicina/uso terapêutico , Administração por Inalação , Adolescente , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Líquido da Lavagem Broncoalveolar/microbiologia , Infecções por Burkholderia/complicações , Complexo Burkholderia cepacia/crescimento & desenvolvimento , Complexo Burkholderia cepacia/isolamento & purificação , Ceftazidima/administração & dosagem , Ceftazidima/farmacologia , Criança , Fibrose Cística/microbiologia , Farmacorresistência Bacteriana Múltipla , Quimioterapia Combinada , Inglaterra , Feminino , Humanos , Infusões Intravenosas , Masculino , Testes de Sensibilidade Microbiana , Penicilinas/administração & dosagem , Penicilinas/farmacologia , Tobramicina/administração & dosagem , Tobramicina/farmacologia , Resultado do TratamentoRESUMO
The involvement of all user groups, including children, young people (CYP) and their parents, encourages people to take responsibility for healthier lifestyle behaviours, improves treatment compliance and leads to more appropriate use of healthcare resources. Initiatives to engage CYP in the UK are gathering momentum, but significant improvements are still needed. There is a national drive from the department of health (DH) and NHS England, strategic clinical networks, operational delivery networks (including newborn networks), charities, parent groups and a number of other bodies to embed CYP involvement in service design and delivery. User engagement and patient choice, is underpinned by the NHS outcomes framework, and a myriad of other DH and NHS England policies and practice frameworks. It is now everybody's business.
