Early eradication therapy againstPseudomonas aeruginosain cystic fibrosis patients

Abstract

In cystic fibrosis (CF) patients early antibiotic treatment of lung infection has been shown to lead to Pseudomonas aeruginosa eradication. The present study determined: 1) the time period from eradication to new P. aeruginosa acquisition; 2) P. aeruginosa re-growth and new acquisition; and 3) the impact of eradication therapy on lung function, antimicrobial resistance, emergence of other pathogens and treatment costs.Ciprofloxacin and colistin were used to eradicate P. aeruginosa in 47 CF patients. Bacterial pathogens, lung function decline, P. aeruginosa antimicrobial resistance and anti-pseudomonal serum antibodies were assessed quarterly and compared with an age-matched CF control group. Additionally, costs of antibiotic therapy in both groups were assessed.Early antibiotic therapy leads to a P. aeruginosa free-period of a median (range) of 18 (4-80) months. New acquisition with different P. aeruginosa genotypes occurs in 73% of episodes. It also delays the decline of lung function compared with chronically infected patients, prevents the occurrence of antibiotic resistant P. aeruginosa strains, does not lead to emergence of other pathogens, and significantly reduces treatment costs. The treatment substantially lowers P. aeruginosa prevalence in CF.In conclusion, early antibiotic therapy exerts beneficial effects on the patient's clinical status and is cost-effective compared with conventional antibiotic therapy for chronically infected cystic fibrosis patients.

Eradication ofPseudomonas aeruginosain cystic fibrosis

“…We read with interest the recently published article by TACCETTI et al [1] in the European Respiratory Journal and the accompanying editorial by JONES [2]. TACETTI et al [1] report on their experience with early eradication therapy against Pseudomonas aeruginosa (PA) in cystic fibrosis (CF), concluding that this treatment exerts a number of beneficial effects and is also cost-effective.…”

“…TACETTI et al [1] report on their experience with early eradication therapy against Pseudomonas aeruginosa (PA) in cystic fibrosis (CF), concluding that this treatment exerts a number of beneficial effects and is also cost-effective. However, as stated in the editorial [2], questions pertaining to many details of eradication therapy, such as the choice and combination of antibiotics, dosages and modes of delivery, and, in particular, the optimal duration of treatment remain as yet unanswered.…”

“…(colistin or gentamicin) for the following 2 yrs. TACCETTI et al [1] also assessed the effect of their eradication regimen on the basis of three consecutive negative cultures from ''respiratory secretions'' and negative serum antibody titres against PA within a 6-month period after treatment, backed up with an assessment of PA genotypes in a subgroup of their patients. In contrast, the bacteriological outcome in our study was defined on the basis of bronchoalveolar lavage fluid findings, in combination with three subsequent sputum samples.…”

“…TACCETTI et al [1] tried to eradicate PA with inhaled colistin and oral ciprofloxacin administered for 3 weeks. They continued treatment for a total of 3 months when PA was not eradicated after these first 3 weeks.…”

Eradication ofPseudomonas aeruginosain cystic fibrosis patients

“…This situation is not likely to change by comparing small studies employing different methodologies in different settings, particularly our study [1] with that of EBER et al [2]. Clearly, larger studies have to be undertaken to provide a better basis for a consensus in this context.…”