The approach to Pseudomonas aeruginosa in cystic fibrosis.

Pseudomonas aeruginosa continues to be the most common pathogen in cystic fibrosis (CF) lung disease, and chronic infection with mucoid strains is associated with an accelerated decline in lung function. Although multiple factors can potentially explain the susceptibility of CF airways to this organism, their individual relevance is still largely unclear. Prevention of infection remains an important task, and hygiene measures have been successful in reducing cross-infection, but the universal presence of the organism creates an ongoing challenge, and vaccination strategies have not been highly successful to date. Over the last decade treatment strategies have shifted from controlling chronic infection to attempting to eradicate P. aeruginosa in the early stages of infection. Multiple strategies have been shown to be efficacious, but the optimal form and duration of therapy have yet to be defined. Inhaled antibiotics are a key component of maintenance therapy for chronic infection, and the spectrum of available compounds is rapidly expanding. Pulmonary exacerbations can be reduced with this strategy but usually require intravenous antibiotic therapy once they occur. Nonantibiotic approaches to address P. aeruginosa infection are currently being developed and may expand the therapeutic repertoire in the future.