Pseudomonas eradication in cystic fibrosis: who will join the ELITE?
- Correspondence to Dr Alan R Smyth, Associate Professor & Reader in Child Health, Division of Child Health, & Nottingham Respiratory Biomedical Research Unit, E Floor, East Block, Queens Medical Centre, Nottingham NG7 2UH UK;
Arguably, the most significant event in the life of a person with cystic fibrosis (CF) is the acquisition of chronic pulmonary infection with Pseudomonas aeruginosa. It heralds, in many cases, more hospitalisations,1 a more rapid decline in pulmonary function and a shorter life expectancy.2 P aeruginosa has the ability to form biofilms which are composed of non-motile organisms embedded in an exopolysaccharide matrix and which confer resistance to antibiotics.3 In individuals with CF, biofilms have been observed in lungs examined at autopsy and explanted lungs from transplant recipients.4 The extraordinary persistence of infection with P aeruginosa in the CF lung is thought to derive from biofilm formation. The mucoid phenotype of P aeruginosa is a marker of biofilm formation,4 and this phenotype is in turn associated with a worse prognosis compared with non-mucoid organisms.5 However, in the initial stages of infection when the organism is mainly in planktonic form, there is an opportunity to eradicate the infection before it becomes persistent.
The first randomised controlled trial of an eradication regimen for early P aeruginosa infection was reported by Valerius and Koch in 1991.6 This evaluated a 3-week regimen of nebulised colistin and oral ciprofloxacin …