Spanish consensus on the prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients

Arch Bronconeumol. 2015 Mar;51(3):140-50. doi: 10.1016/j.arbres.2014.09.021. Epub 2015 Jan 20.
[Article in English, Spanish]

Abstract

Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P.aeruginosa. At initial infection, inhaled colistin (0,5-2MU/tid), tobramycin (300mg/bid) or aztreonam (75mg/tid) with or without oral ciprofloxacin (15-20mg/kg/bid, 2-3weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P.aeruginosa infections and "patient-to-patient transmission" of this pathogen.

Keywords: Antibiotic treatment; Bronchial infection; Cystic fibrosis; Fibrosis quística; Infección bronquial; Pseudomonas aeruginosa; Tratamiento antibiótico.

Publication types

  • Consensus Development Conference
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Chronic Disease
  • Cystic Fibrosis / complications*
  • Disease Progression
  • Humans
  • Pseudomonas Infections / drug therapy*
  • Pseudomonas Infections / etiology
  • Pseudomonas Infections / prevention & control*
  • Pseudomonas aeruginosa*

Substances

  • Anti-Bacterial Agents