Antibiotic therapy for Pseudomonas aeruginosa infection

There is some evidence that early intensive antibiotic treatment of initial Pseudomonas aeruginosa strains leads to eradication of infection. This treatment is offered by specialist CF centres to all affected patients.

There is no current evidence to suggest the best treatment protocol for P. aeruginosa eradication; several different protocols have been shown to be helpful. Oral and nebulised antibiotics for P. aeruginosa eradication need to be given for 2 to 3 months. Short courses of intravenous antibiotics can also be used.

Repeated eradication treatment can be considered for repeat infections.

Once chronic P. aeruginosa infection is established, antibiotic treatment aims to suppress infection and reduce morbidity. At the time of writing, there is little evidence to support one particular choice of treatment, and antibiotic regimens vary. Many patients with chronic P. aeruginosa infection are managed with long-term inhaled antibiotics.

There is good evidence that patients with chronic P. aeruginosa infection show clinical improvement following treatment with the macrolide antibiotic azithromycin. The benefit is due to azithromycin’s anti-inflammatory effect, rather than its antibiotic properties; see Anti-inflammatory treatment for cystic fibrosis for further information.