Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Continuous vs thrice-daily ceftazidime for elective intravenous antipseudomonal therapy in cystic fibrosis



We hypothesized that a continuous 24-h infusion of 100 mg/kg per day ceftazidime (treatment C) would result in equivalent or even superior anti-infectious efficacy in chronic Pseudomonus aeruginosa (PA) infection in patients with cystic fibrosis (CF) in comparison to the usual application of 200 mg/kg per day ceftazidime in three doses (treatment T).


This was a randomized crossover study comparing outcome after 14 days and 35 days. Tobramycin administered once daily (10 mg/kg per day) was administered concomitantly in both groups. The primary end-point was a decrease in the leukocyte count, and the secondary endpoints were clinical and lung function parameters, Pseudomonas quantification in sputum, and inflammation markers (immunogloblulin [Ig] G, C-reactive protein [CRP]) in serum. All patients received antibiotics electively as 14-day courses on a regular basis, not for acute exacerbations.


Fifty-six patients (29 females, mean patient age 14.4 years, age range 5–37) initially received treatments C or T, followed by the alternative treatment after amean interval of 37 (± 21) weeks. After 2 weeks of antibiotic treatment, the overall study group showed significant improvements compared to baseline for body weight, leukocyte counts, CRP, forced expiratory volume in 1 s (FEV1), FVC (forced vital capacity), and bacterial load in the airways, with no significant differences between treatment groups. Both regimens were well tolerated. Threeweeks after cessation of antimicrobial therapy, leukocytes and PA density had returned to pre-treatment values.


We conclude that continuous or thrice-daily dosing of intravenous ceftazidime, both combined with once-daily tobramycin, are equally effective application regimens for elective antipseudomonal therapy in clinically stable patients with CF.

This is a preview of subscription content, log in to check access.


  1. 1.

    Schaedel C, de Monestrol I, Hjelte L, Johannesson M, Kornfalt R, Lindblad A, Strandvik B, Wahlgren L, Holmberg L: Predictors of deterioration of lung function in cystic fibrosis. Pediatr Pulmonol 2002; 33: 483–491.

  2. 2.

    Schoeni MH, Casaulta-Aebischer C: Nutrition and lung function in cystic fibrosis patients: review. Clin Nutr 2000; 19: 79–85.

  3. 3.

    Steinkamp G, Wiedemann B: Relationship between nutritional status and lung function in cystic fibrosis: cross sectional and longitudinal analyses from the German CF quality assurance (CFQA) project. Thorax 2002; 57: 596–601.

  4. 4.

    Doering G, Conway SP, Heijerman HG, Hodson ME, Hoiby N, Smyth A, Touw DJ: Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus. Eur Respir J 2000; 16: 749–767.

  5. 5.

    Kercsmar CM, Stern RC, Reed MD, Myers CM, Murdell D, Blumer JL: Ceftazidime in cystic fibrosis: pharmacokinetics and therapeutic response. J Antimicrob Chemother 1983; 12[Suppl A]: 289–295.

  6. 6.

    Permin H, Koch C, Hoiby N, Christensen HO, Moller AF, Moller S: Ceftazidime treatment of chronic Pseudomonas aeruginosa respiratory tract infection in cystic fibrosis. J Antimicrob Chemother 1983; 12[Suppl A]: 313–323.

  7. 7.

    Vinks AA, Brimicombe RW, Heijerman HG, Bakker W: Continuous infusion of ceftazidime in cystic fibrosis patients during home treatment: clinical outcome, microbiology and pharmacokinetics. J Antimicrob Chemother 1997; 40: 125–133.

  8. 8.

    Rappaz I, Decosterd LA, Bille J, Pilet M, Belaz N, Roulet M: Continuous infusion of ceftazidime with a portable pump is as effective as thrice-a-day bolus in cystic fibrosis children. Eur J Pediatr 2000; 159: 919–925.

  9. 9.

    Riethmueller J, Busch A, Damm V, Ziebach R, Stern M: Home and hospital antibiotic treatment prove similarly effective in cystic fibrosis. Infection 2002; 30: 387–391.

  10. 10.

    Doering G, Obernesser HJ, Botzenhart K, Flehmig B, Hoiby N, Hofmann A: Proteases of Pseudomonas aeruginosa in patients with cystic fibrosis. J Infect Dis 1983; 147: 744–750.

  11. 11.

    Bauernfeind A, Bertele R, Harms K, Hörl G, Jungwirth R, Petermueller C, Przyklenk B, Weisslein-Pfister C: Qualitative and quantitative microbiological analysis of sputa of 102 patients with cystic fibrosis. Infection 1987; 15: 270–277.

  12. 12.

    Hoppe JE, Theurer-Mainka U, Stern M: Comparison of three methods for culturing throat swabs from cystic fibrosis patients. J Clin Microbiol 1995; 33: 1896–1898.

  13. 13.

    Quanjer PH: Standardized lung function testing. Report Working Party “Standardization of Lung Function Tests”, European Community for Coal and Steel. Bull Eur Physiopathol Respir 1983; 19: 1–95.

  14. 14.

    Zapletal A, Samanek M, Paul T: Lung function in children and adolescents. Methods, reference values. Karger, Basel, 1987.

  15. 15.

    Salh B, Bilton D, Dodd M, Abbot J, Webb K, et al: A comparison of aztreonam and ceftazidime in the treatment of respiratory infections in adults with cystic fibrosis. Scand J Infect Dis 1992; 24: 215–218.

  16. 16.

    Cunningham S, McColm JR, Mallinson A, Boyd I: Duration of effect of intravenous antibiotics on spirometry and sputum cytokines in children with cystic fibrosis. Pediatr Pulmonol 2003; 36: 43–48.

  17. 17.

    Berkhout J, Visser LJ, van den Broek PJ, van de Klundert JA, Mattie H: Clinical pharmacokinetics of cefamandole and ceftazidime administered by continuous intravenous infusion. Antimicrob Agents Chemother 2003; 47: 1862–1866.

  18. 18.

    Byl B, Baran D, Jacobs F, Herschuelz A, Thys JP: Serum pharmacokinetics and sputum penetration of amikacin 30 mg/kg once daily and of ceftazidime 200 mg/kg/day as a continuous infusion in cystic fibrosis patients. J Antimicrob Chemother 2001; 48: 325–327.

  19. 19.

    Kuzemko J, Crawford C: Continuous infusion of ceftazidime in cystic fibrosis. Lancet 1989; 2: 385.

  20. 20.

    Vinks AA, Mouton JW, Touw DJ, Heijerman HG, Danhof M, Bakker W: Population pharmacokinetics of ceftazidime in cystic fibrosis patients analyzed by using a nonparametric algorithm and optimal sampling strategy. Antimicrob Agents Chemother 1996; 40: 1091–1097.

  21. 21.

    Vinks AA, Touw HG, Heijerman M, Danhof G, de Leede P, Bakker W: Pharmacokinetics of ceftazidime in adult cystic fibrosis patients during continuous infusion and ambulatory treatment at home. Ther Drug Monit 1994; 16: 341–348.

  22. 22.

    Alou L, Aguilar, L, Sevillano, D, Gimenez M-J, Echeverria O, Gomez-Lus ML, Prieto J: Is there a pharmacodynamic need for the use of continuous versus intermittent infusion with ceftazidime against Pseudomonas aeruginosa? An in vitro pharmacodynamic model. J Antimicrob Chemother 2005; 55: 209–213.

Download references

Author information

Correspondence to J. Riethmueller.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Riethmueller, J., Junge, S., Schroeter, T.W. et al. Continuous vs thrice-daily ceftazidime for elective intravenous antipseudomonal therapy in cystic fibrosis. Infection 37, 418 (2009).

Download citation


  • Ceftazidime
  • Forced Vital Capacity
  • Tobramycin
  • Acute Exacerbation
  • Lung Function Parameter