An evaluation of the safety and efficacy of aztreonam versus azlocillin plus tobramycin in the treatment of pulmonary exacerbations in cystic fibrosis patients

Cystic fibrosis was first described as a disease entity in 1938 by Dorothy Anderson and was named cystic fibrosis of the pancreas. It was not until nearly twenty years later that Shwachman and colleagues found that over 15 percent of patients diagnosed with cystic fibrosis did not have pancreatic involvement. Today, cystic fibrosis is recognized as a complex condition involving many abnormalities. The classic triad of diagnostic findings includes pancreatic insufficiency, obstructive pulmonary disease, and a positive sweat chloride test. Other common findings and or consequences of cystic fibrosis are congestive heart failure, sterility or decrease fertility, hepatic or biliary cirrhosis, and arthritis. Cystic fibrosis is the most common lethal genetic disease of Caticasians, occurring in one out of every 2000 births in this population. The assumption has been made that this disease is inherited as an autosomal recessive trait based on the evidence of population genetics data. Recent findings seem to confirm this suspicion by location of the common variant of the cystic fibrosis gene on the seventh chromosome. Despite advances in both genetic and pharmacologic research as many as one-half of cystic fibrosis patients die by 20 years of age. Also, 90 to 98 percent of mortality in this patient population who are one year of age or greater is ascribed to pulmonary disease. Pulmonary infections requiring hospitalization due to decreased pulmonary function remain the leading cause of associated morbidity and expense to the patient and their family. The purpose of this study was to evlaute and compare the safety and efficacy of aztreonam in pulmonary exacerbations of cystic fibrosis associated with Gram-negative pathogens in both pediatric and young adult patients to one standard antimicrobial therapy consisting of azlocillin and tobramycin.