Pseudomonas aeruginosa eradication therapy on Cystic Fibrosis- Guideline and clinical routine

Abstract

Background: One important risk factor for reduced survival of Cystic fibrosis patients is chronical pulmonary infection with Pseudomonas aeruginosa (PSA). Between first detection and chronical infection is a window of opportunity to eradicate colonization of PSA. Question: Are Cystic Fibrosis (CF) patients in Germany treated as recommended by the guideline published by The “Society of pediatric pneumology”, which is not legally binding? Method: We designed a questionnaire regarding PSA eradication treatment and emailed it to all CF centers (CFC) in Germany. Results: 29 out of 90 CFC answered. They were responsible for 2090 CF patients of whom 1154 are children. This covers slightly more than one quarter of all German CF patients. The questions were categorized in diagnostic, initial therapy, control of success and rescue treatment. For diagnosis five (17%) clinics deviate from the guideline: they started therapy after the second positive testing. The initial therapy in ten (34%) CFC differed from guideline. Nine (31%) of them used a combination of Ciprofloxacin and Tobramycin. The guideline was again ignored by 14 (48%) CFC regarding the success of treatment. 7(24%) even didn’t use antibody testing. Five (17%) CFC didn´t state any rescue therapy. All in all 20 (68%) CFCs deviate from guideline in at least one category of PSA eradication. Discussion: Non-guideline based therapies of more than half of the CF patients seem really high. But it may contribute to the low acceptance rate, that the guideline is a recommendation based on just a few studies and even a late Cochrane-Review isn´t able to state an optimal eradication therapy.