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Abstract
Background:
Pseudomonas aeruginosa (Pa) is the predominant pathogen infecting the airways of patients with cystic fibrosis (CF). Initial colonization is usually transient and associated with non-mucoid strains, which can be eradicated if identified early. This strategy can prevent, or at least delay, chronic Pa infection, which eventually develops in the majority of patients by their late teens or early adulthood. This article discusses the management and latest treatment developments of Pa lung infection in patients with CF, with a focus on nebulized antibiotic therapy.
Methods:
PubMed was searched to identify English language articles published up until August 2011 using combinations of the following key words: ‘antibiotics’, ‘chronic’, ‘cystic fibrosis’, ‘eradication’, ‘exacerbations’, ‘guidelines’, ‘inhaled’, ‘intravenous’, ‘lung infection’, ‘burden’, ‘adherence’, ‘patient segregation’, ‘pseudomonas aeruginosa’ and ‘resistance’.
Findings:
Antibiotics form a central part of the treatment regimens for chronic Pa lung infection. Current treatment guidelines recommend that patients with chronic pulmonary infection with Pa should receive long-term inhaled anti-pseudomonal therapy to preserve lung function, and to reduce the frequency of pulmonary exacerbations and hospital admissions. While antibiotic resistance seems to increase with frequent antibiotic use, this does not appear to impact on clinical outcome. Negative aspects of therapy include the time needed for drug administration and subsequent cleaning of the equipment. These factors cause a significant treatment burden and impact on adherence. The availability of more convenient formulations and delivery vehicles for anti-pseudomonal antibiotics may help overcome some of these challenges.
Conclusions:
Current challenges in the management of CF patients with chronic Pa lung infection are numerous. The availability of novel anti-pseudomonal antibiotic formulations/devices is anticipated to improve treatment adherence in patients with CF, and could improve clinical outcomes. Thus, there is hope for improved survival in individuals with CF suffering from chronic pulmonary infection with Pa.
Transparency
Declaration of funding
This paper was funded by Novartis Pharma AG (Basel, Switzerland).
Declaration of financial/other relationships
D.P. has received research grants from Novartis and Pfizer, and sponsorship from Gilead to attend ECFS 2011. P.G. and P.W. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.
CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.
Acknowledgments
Editorial assistance was provided by Melanie Stephens and Mary Sayers (CircleScience, Macclesfield, UK), funded by Novartis.
Previous presentation: this manuscript reviews published literature, including the following six abstracts.
Stass H, Baumann-Noss, Delesen H et al. Presented at the 31st European Cystic Fibrosis Conference, Prague, Czech Republic, 11–14 June 2008
Wilson J, Moorehead L, Montgomery B. Presented at the 22nd Annual North American Cystic Fibrosis Conference, Orlando, USA, 23–25 October 2008
Geller DE, Flume P, Schwab R et al. Presented at the 22nd Annual North American Cystic Fibrosis Conference, Orlando, USA, 23–25 October 2008
Griffith DC, Hansen C, Pressler T et al. Presented at the 31st European Cystic Fibrosis Conference, Prague, Czech Republic, 11–14 June 2008
Bruinenberg P, Otulana D, Blanchard J et al. Presented at the 22nd Annual North American Cystic Fibrosis Conference, Orlando, USA, 23–25 October 2008
Dupont L, Minic P, Fustik S et al. Presented at the 31st European Cystic Fibrosis Conference, Prague, Czech Republic, 11–14 June 2008