Changes in strategies for optimal antibacterial therapy in cystic fibrosis

Aggressive antibiotic therapy of bacterial airway infection is one of the m ain reasons for the dramatic increase in life expectancy over the last few decades. Staphylococcus aureus and Haemophilus influenzae are the predomina nt pathogens in younger patients. but the choice of antibiotic therapy agai nst these pathogens remains highly controversial. There is general agreemen t that patients with pulmonary exacerbations should be treated and many cys tic fibrosis (CF) centres will also try to eradicate bacteria in the absenc e of symptoms. Prophylactic antibiotic therapy, with anti-staphylococcal me dications started at the time of diagnosis, is advocated by some groups but its positive effect remains unproven. Tn fact, recent studies have suggest ed that continuous prophylactic treatment with anti-staphylococcal antibiot ics may increase the risk of early colonisation with P. seudomonas aerugino sa. P, aeruginosa is the main pathogen in older children with CF. While chr onic airway infection with mucoid P. aeruginosa is considered irreversible, both the combination of oral ciprofloxacin with inhaled colistin and inhal ed to bramycin alone has been used successfully in the early phase of colon isation. In patients chronically infected with P, aeruginosa, standard trea tment of pulmonary exacerbations consists of intravenous combination therap y for 2-3 weeks. Controversy exists whether this treatment should be perfor med routinely every 3 months or only in the presence of a pulmonary exacerb ation. Inhaled antibiotics such as tobramycin have been shown to improve lu ng function and reduce sputum density of P. aeruginosa, but both the optima l dose and the duration of therapy are unclear at the present time. (C) 200 1 Elsevier Science B.V. and International Society of Chemotherapy. All righ ts reserved.