Elective versus symptomatic antibiotic treatment in cystic fibrosis patients with chronic Pseudomonas infection of the lungs

Background-A previous retrospective study suggested that a policy of regula r anti-pseudomonal antibiotic treatment improved pulmonary function and inc reased survival in patients with cystic fibrosis chronically infected with Pseudomonas species. The results of a prospective multicentre study to comp are the effects on pulmonary function and mortality of three monthly electi ve anti-pseudomonal antibiotic treatment with conventional symptomatic trea tment are reported. Methods-Sixty patients with cystic fibrosis, chronically infected with P ae ruginosa, were randomised to the two treatment arms (elective or symptomati c) and followed clinically at yearly reviews. The major end points were cha nges in forced expiratory volume in one second (FEV1) and forced vital capa city (FVC). Survival was a secondary end point. Results-Patients in the symptomatic group received a mean of three antibiot ic treatments each year and those in the elective group received four antib iotic treatments during each year of the study. No significant differences in FEV1 and FVC were found between the two groups after three years. There was a statistically non-significant higher rate of deaths in the elective g roup (n = 4), three of which were associated with B cepacia infection, comp ared with the symptomatic group (n = 0). Conclusions-This study did not demonstrate an advantage of a policy of elec tive antibiotic treatment over symptomatic treatment in patients with cysti c fibrosis chronically infected with Pseudomonas species.