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Prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients: Spanish Consensus

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 cystic fibrosis-patients.

A culture based microbiological follow-up should be performed in patients with no infection with Pseudomonas aeruginosa.

At initial infection, inhaled Colistin ( 0.5-2 MU/tid ), Tobramycin ( 300 mg/bid ) or Aztreonam ( 75 mg/tid ) with or without oral Ciprofloxacin ( 15-20 mg/kg/bid, 2-3 weeks ) 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 ( 2-3 weeks ) 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 Pseudomonas aeruginosa infections and patient-to-patient transmission of this pathogen. ( Xagena )

Cantón R et al, Arch Bronconeumol 2015; Epub ahead of print