General Health

Role of Antibiotics and Nutrient Supplements in Cystic Fibrosis

Treatment

While there are no known cures for Cystic Fibrosis, there are various treatments available. For the last 70 years, CF management has substantially improved. Infants born with it 70 years ago were unlikely to live past their first year, while today’s infants are likely to live well into adulthood. Individuals with cystic fibrosis can now live a healthier, less restricted life because of recent advancements in cystic fibrosis treatment. The proactive treatment of airway infection, as well as the promotion of an appropriate diet and an active lifestyle, are the basis of management.

Pulmonary rehabilitation is a type of CF treatment that lasts the rest of a person’s life and aims to improve organ function and thus wellbeing. Energy conservation techniques (ECT) are used by occupational therapists in the rehabilitation of Cystic Fibrosis patients. Ergonomic principles, pursed-lip breathing, and diaphragmatic breathing are examples of energy conservation techniques. Since people with CF often experience fatigue and dyspnea as a result of chronic lung infections, lowering the amount of energy expended during activities can help patients feel better and acquire more control.

Current treatments can only postpone the deterioration of organ function at best. Because disease symptoms vary so widely, therapy is usually done in specialised interdisciplinary clinics and is personalised to the individual. Lungs, gastrointestinal tract (including pancreatic enzyme supplements), reproductive organs (including assisted reproductive technologies), and psychological support are also targets for therapy.

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Limiting and treating lung damage caused by thick mucus and infection is the most continuous part of CF therapy, to prolong life. Antibiotics are administered intravenously, inhaled, and orally to treat both chronic and acute illnesses. To change and clear the thickened mucus, mechanical components and inhalation medications are used. While these treatments are effective, they can be time-consuming. Those with significantly low oxygen levels might consider home oxygen therapy. Many people with CF take probiotics, which are supposed to help with intestinal gut microbiome and inflammation. However, the evidence supporting probiotics’ effectiveness in lowering pulmonary exacerbations in persons with CF is equivocal.

Role of antibiotics

Many patients with CF are taking several or more antibiotics all of the time, even when they are well, to prevent infection. Antibiotics are required if pneumonia is suspected or a significant reduction in lung function is observed, and are normally prescribed based on the findings of a sputum analysis and the patient’s previous reaction. This lengthy therapy frequently necessitates admission to the hospital and the placement of a more permanent IV, such as a peripherally placed central catheter or a Port-a-Cath.

Inhaled antibiotics such as tobramycin, colistin, and aztreonam are commonly used for months at a time to enhance lung function by inhibiting colonised bacteria’s proliferation. The inhaled antibiotic treatment enhances lung function by preventing infection, but it also has downsides such as antibiotic resistance, tinnitus, and voice alterations. In persons with cystic fibrosis who are infected with Pseudomonas aeruginosa, inhaled levofloxacin may be used to treat the infection.

Early treatment of Pseudomonas aeruginosa infection is easier and more effective, with nebulized medicines combined with or without oral antibiotics capable of eradicating the bacteria for up to two years. It’s still unclear whether antibiotics should be chosen based on the findings of testing drugs separately (one at a time) or in combination to treat CF patients with lung infections caused by Pseudomonas aeruginosa.

Antibiotics used orally, such as ciprofloxacin or azithromycin, are used to help prevent or treat the infection. Long-term use of aminoglycoside antibiotics (e.g. tobramycin) can result in hearing loss, impairment of the inner ear’s balancing system, or renal failure. The level of antibiotics in the blood is frequently checked and adjusted to avoid severe adverse effects.

All of these aspects, including the usage of antibiotics, the severity of the disease, and the rise of antibiotic-resistant bacteria, necessitate more research into new techniques, such as antibiotic adjuvant treatment. Antibiotics for pulmonary exacerbations in persons with cystic fibrosis and Burkholderia cepacia complex, as well as antibiotics to treat nontuberculous mycobacteria in people with CF, are still untested in clinical trials.

Nutrient supplementation

It’s unknown whether vitamin A or beta-carotene supplementation helps with vitamin A deficiency-related eye and skin disorders.

There is no good evidence that increasing vitamin D intake can prevent osteoporosis in cystic fibrosis patients.

There is evidence that vitamin E supplementation may enhance vitamin E levels in persons with cystic fibrosis, while it is yet unclear what effect supplementation has on vitamin E-specific deficient problems or lung function.

Multiple research has looked into the benefits and drawbacks of omega-3 fatty acid supplementation for cystic fibrosis patients, however, the evidence is inconclusive.

Transplantation 

As lung function and exercise tolerance decline in people with CF, lung transplantation may become necessary. Because the remnant lung may retain bacteria that could infect the transplanted lung, people with CF must have both lungs replaced. A pancreas or liver transplant may be performed simultaneously to treat liver disease and/or diabetes. When a person’s lung function deteriorates to the point where mechanical help is required or survival is compromised, lung transplantation may be considered.

Author

 Yash Batra

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