Systematic review of antistaphylococcal antibiotic therapy in cystic fibrosis

Background-The respiratory tract in patients with cystic fibrosis is freque ntly colonised with Staphylococcus aureus. There is great diversity of clin ical practice in this area of cystic fibrosis. A systematic review was cond ucted to study the evidence relating antistaphylococcal therapy to clinical outcome in patients with cystic fibrosis. Methods-A search strategy already evaluated for the study of the epidemiolo gy of cystic fibrosis clinical trials was used. This yielded 3188 reference s from which 13 clinical trials of antistaphylococcal therapy were identifi ed. Results-Substantial heterogeneity was observed between trials. In the 13 cl inical trials a total of 19 antibiotics were used to assess a wide variety of outcome measures (11 clinical, six laboratory). Both intermittent and co ntinuous treatment strategies were used. Sputum clearance of S aureus was m ore frequently achieved than any other beneficial outcome. A beneficial eff ect on pulmonary function was rarely measured or observed. Although five ra ndomised clinical trials were identified, the extent of heterogeneity precl uded the use of meta-analysis for further synthesis of information. Conclusions-Antistaphylococcal treatment achieves sputum clearance of S aur eus in patients with cystic fibrosis. Prophylactic antistaphylococcal treat ment in young children with cystic fibrosis is likely to be of clinical ben efit. It remains to be determined whether the use of "prophylactic" versus "intermittent" antistaphylococcal therapy in cystic fibrosis is associated with improved lung function and/or chest radiographic scores, an increase i n bacterial resistance, or earlier acquisition of Pseudomonas aeruginosa. A large randomised clinical trial lasting approximately two years is urgentl y required to address this problem.