Spanish Consensus on the Prevention and Treatment of Pseudomonas aeruginosa Bronchial Infections in Cystic Fibrosis Patients

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 have modified the management of CF-patient. 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 rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P. aeruginosa infections and cross transmission of this pathogen.