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As paradoxical as it may seem, the more we learn about some disease processes, the more we appreciate the challenges in refining their management. Airway infection in persons with cystic fibrosis (CF) is a case in point. For decades, our approach has been to apply Koch’s postulate to CF airway infections: bacteria in the airways are pathogens and antimicrobial therapy targeting these species improves health. The steadily improving health of the CF population as availability and use of antimicrobial therapies have increased has understandably reinforced this paradigm. However, as our appreciation of the complexity of CF airway microbiology has also increased it has become clear that we have been treating a poorly understood and complex infection with a set of therapies that are also rather poorly understood, at least with respect to their cumulative impact(s) on that system. Given what we know—and still don’t know—about this system, can we refine/improve outcomes? Is it reasonable to consider that reducing treatment complexity in this scenario may provide as much, or possibly more, benefit as adding further treatments?
But testing this hypothesis is challenging. First, although changes in therapy must, by definition, involve a deviation from the current care standards, there is generally greater comfort with adding a new therapy rather than subtracting an …
Contributors DV and JL: substantial contributions to the conception or design of the work; the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.