Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: a European consensus

Cystic fibrosis (CF) is the most common lethal hereditary disorder with aut osomal recessive heredity in caucasians. The majority of CF patients suffer from chronic respiratory infection with the opportunistic bacterial pathog en Pseudomonas aeruginosa. No consensus among clinicians has been reached s o far concerning antibiotic treatment against P. aeruginosa in CF patients. Consensus answers to 24 important questions in this context, based on curre nt evidence, are presented, given by a panel of 34 European experts. Questi ons addressed and answered are: The diagnosis of P. aeruginosa lung coloniz ation in CF; The impact of P. aeruginosa on the clinical state of CF patien ts; The assessment of P. aeruginosa susceptibility against antibiotics and the importance of these results for the clinician; The use of monotherapy v ersus combination therapy; The development of microbial resistance; The ach ievement of optimal airway concentrations; The effects of subinhibitory con centrations of antibiotics on P. aeruginosa; Statements on the pharmacokine tics of antibiotics in CF patients; Recommendations for doses and dosing in tervals and length of treatment regimens; and Toxic side effects due to rep eated antibiotic therapy was addressed, The expert panel answered further questions on the use of fluoroquinolones in children with CF, on the administration of nebulized antibiotics and whe ther prevention of P. aeruginosa lung colonization is possible in CF using antibiotic therapy. Problems of antibiotic therapy at home and in the hospital were addressed, a consensus statement on regular maintenance treatment, or treatment on dem and, was given and different routes of administration of antibiotics were r ecommended for different clinical situations. Finally, the factors which determine the choice of the antibiotic, the dosa ge, and the duration of the treatment in cystic fibrosis patients were addr essed and the design of future antibiotic studies in the context of Pseudom onas aeruginosa lung infection in cystic fibrosis patients were recommended .