What have we learned about early treatment of Pseudomonas aeruginosa infection in infants and children with cystic fibrosis?

摘要

The study by treggiari et al published in this issue of the Archives of Pediatrics & Adolescent Medicine represents the latest paradigm shift in the antimicrobial management of people with cystic fibro-sis (CF). It is worthwhile to reflect on the sea changes that have occurred in the antimicrobial management of patients with CF during the past 3 decades. During the 1970s and 1980s, clinicians questioned the need for antimicrobial therapy during a pulmonary exacerbation. To assess this, a placebo-controlled trial was conducted in which patients having an exacerbation were randomized to antibiotics vs placebo. There was a death in the placebo group. Investigators then asked if clinical improvement during CF exacerbations was the result of antibiotics or the result of the supportive care (eg, rest, bron-chodilators, more effective chest physiotherapy) that patients received while hospitalized.