ISOLATION AND TREATMENT OF CYSTIC-FIBROSIS PATIENTS WITH LUNG INFECTIONS CAUSED BY PSEUDOMONAS-(BURKHOLDERIA)-CEPACIA AND MULTIRESISTANT PSEUDOMONAS-AERUGINOSA

Cross-infection with Pseudomonas aeruginosa and Pseudomonas cepacia ha s been shown sometimes to occur between cystic fibrosis (CF) patients in some CF centres, in some summer camps and during some social contac ts between CF patients. Cohort isolation and improved hygienic precaut ions, however, have successfully been employed in some CF centres resu lting in a decrease or elimination of cross-infection. Chronic P. aeru ginosa infection is in most CF patients preceded by a period of interm ittent colonization. Early aggressive chemotherapy (oral ciprofloxacin and nebulized colistin for 3 weeks) every time P. aeruginosa is detec ted in sputum has significantly decreased the incidence of new chronic infection in CF patients. Chronic P. aeruginosa infection can be trea ted by ''maintenance chemotherapy'' (= chronic suppressive chemotherap y). The principle is to restore lung function repeatedly by regular 2- week courses of intensive intravenous treatment every 3 months in the CF centre and adding daily inhalations of colistin between the courses , and sometimes also by giving oral ciprofloxacin during these interva ls to unstable patients. Eradication of P. cepacia infection is virtua lly never obtained by antibiotic treatment with, e.g., ceftazidime and tobramycin or co-trimoxazole. Chronic suppression with doxycyclin or co-trimoxazole may give rise to some improvement in the clinical sympt oms.