September 01, 2011
1 min read

BAL-directed therapy showed little effect on Pseudomonas aeruginosa prevalence in infants with CF

Wainwright CE. JAMA. 2011;306:163-171.

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Therapy guided by bronchoalveolar lavage in infants with cystic fibrosis failed to lower prevalence of Pseudomonas aeruginosa infection, according to an article published online.

Claire E. Wainwright, MD, and other researchers of the Australian Cystic Fibrosis Bronchoalveolar Lavage trial randomly assigned infants diagnosed with cystic fibrosis between June 1999 and April 2005 to bronchoalveolar lavage (BAL)-directed (n=84) or standard (n=86) therapy. The researchers prescribed treatment according to culture or BAL results. The researchers then followed up with the patients 5 years later, ending in 2009, on prevalence of P. aeruginosa on BAL cultures and total cystic fibrosis high-resolution computed tomography (CF-CT).

The researchers said of 267 infants diagnosed with cystic fibrosis after newborn screening, 157 completed the study. P. aeruginosa infection diagnosed by BAL culture was noted in 10% of patients in the BAL-directed therapy group and 12% in the standard therapy group. Average total CF-CT scores were similar between BAL-directed therapy and standard therapy groups, at 3% and 2.8%, respectively.

“BAL-directed therapy provided no clinical, microbiologic, or radiographic advantage and led to an increased risk of predominantly mild adverse events as a direct result of bronchoscopy, as well as disadvantages such as the need to fast prior to the procedure, exposure to anesthesia, and potential perioperative anxiety,” the researchers said.

Disclosure: The researchers reported financial relationships with: Novartis, Vertex Pharmaceuticals, Gilead Sciences, Inspire Pharmaceuticals, GlaxoSmithKline, Merck, Roche, Pharmaxis, Boehringer-Ingelheim, Insmed, North American Cystic Fibrosis Foundation, the European Cystic Fibrosis Society, the United Kingdom Cystic Fibrosis Trust, the New Zealand Health Research Council, and the Faculty Research Development Fund from the University of Auckland.

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