Reducing Pseudomonas sputum density in bronchiectasis

In patients with bronchiectasis, chronic infection by Pseudomonas aeruginosa is strongly associated with poor clinical outcomes, including more symptoms, worse quality of life, enhanced lung function decline, more frequent exacerbations and a three-fold increase in mortality [1, 2]. Therefore, treatment of chronic P. aeruginosa airway infection has long been regarded as a key priority in the management of bronchiectasis [3, 4]. To this end, a number of previous studies have used inhaled or nebulised antibiotics in these patients, but results are conflicting [5–9]. Most of these studies failed to reach their primary endpoints, although several potentially beneficial effects were observed. In fact, a recent meta-analysis showed that inhaled antibiotic treatment reduces exacerbation frequency in these patients [10] and, indeed, the current European Respiratory Society guidelines recommended long-term use of inhaled antibiotics in patients with chronic P. aeruginosa infection and frequent exacerbations [3]. Yet, many unanswered questions remain, including which is the best antibiotic agent, its dose and/or its method of administration, among others.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Editorials Source Type: research