ANTIBIOTIC-TREATMENT OF INITIAL COLONIZATION WITH PSEUDOMONAS-AERUGINOSA POSTPONES CHRONIC INFECTION AND PREVENTS DETERIORATION OF PULMONARY-FUNCTION IN CYSTIC-FIBROSIS

Chronic pulmonary infection with Pseudomonas aeruginosa (PA) develops in most patients with cystic fibrosis (CF) and is associated with a po or prognosis, Much effort has been directed toward treating the chroni c infection, but it is almost impossible to eradicate it once establis hed; therefore, prevention is preferable. Since 1989 CF patients at th e Danish CF Center in Copenhagen have been treated with an intensive t hree-step-protocol consisting of colistin inhalations and oral ciprofl oxacin at the time of initial PA colonization. This study compares 48 patients treated according to this intensive protocol with 43 historic controls, The study was carried out over 44 months and included 218 p atient-years. Only 16% of the treated patients developed chronic PA in fection after 3 1/2 years compared with 72% of the control patients (K aplan Meier estimate, P < 0.005, log rank test). This indicates that a ggressive treatment prevented or delayed chronic PA infection in 78% o f the patients for 3 1/2 years. Furthermore, aggressive treatment main tained or increased pulmonary function (forced vital capacity and forc ed expiratory volume in 1 second in percent of predicted values) durin g the year after inclusion compared with the control group, in which p ulmonary function declined (P < 0.01, Mann-Whitney test). Although som e of the treated patients eventually developed chronic PA infection, t hese patients had significantly better pulmonary function at the onset of chronic PA infection compared with control patients (P < 0.001, Ma nn-Whitney test). When the different steps in the intensive three-step -protocol were analyzed, there was a trend suggesting that 3 months of high-dose treatment with colistin inhalation and oral ciprofloxacin p roduced the best results in terms of postponement or prevention of chr onic PA infection (P < 0.05). (C) 1997 Wiley-Liss, Inc.