title: Antibiotic adjuvant therapy for pulmonary infection in cystic fibrosis.
abstract: BACKGROUND
  Cystic fibrosis is a multi-system disease characterised by the production of thick secretions causing recurrent pulmonary infection, often with unusual bacteria. This leads to lung destruction and eventually death through respiratory failure. There are no antibiotics in development that exert a new mode of action and many of the current antibiotics are ineffective in eradicating the bacteria once chronic infection is established. Antibiotic adjuvants - therapies that act by rendering the organism more susceptible to attack by antibiotics or the host immune system, by rendering it less virulent or killing it by other means, are urgently needed.
  
  
  OBJECTIVE
  To determine if antibiotic adjuvants improve clinical and microbiological outcome of pulmonary infection in people with cystic fibrosis.
  
  
  METHODS
  We searched the Cystic Fibrosis Trials Register which is compiled from database searches, hand searches of appropriate journals and conference proceedings.Date of most recent search: 26 July 2012.We also searched MEDLINE (all years) on 23 February 2013 and ongoing trials registers on 13 February 2013.
  
  
  METHODS
  Randomised controlled trials and quasi-randomised controlled trials of a therapy exerting an antibiotic adjuvant mechanism of action compared to placebo or no therapy for people with cystic fibrosis.
  
  
  METHODS
  The authors independently assessed and extracted data from identified studies.
  
  
  RESULTS
  We identified eighteen studies of which four are included that examined antibiotic adjuvant therapies, three studies are ongoing. The included studies involve the assessment of β-carotene, garlic and zinc supplementation and KB001 (a biological agent). No therapy demonstrated a significant effect upon pulmonary function, pulmonary exacerbations or quality of life. The study of zinc supplementation reports a reduction in the requirement of oral antibiotics but not of intravenous antibiotics, an effect that is difficult to understand.
  
  
  CONCLUSIONS
  We could not identify an antibiotic adjuvant therapy that could be recommended for the treatment of lung infection in those with cystic fibrosis. The emergence of increasingly resistant bacteria makes the reliance on antibiotics alone challenging for cystic fibrosis teams. There is a need to explore alternative strategies, such as the use of adjuvant therapies. Further research is required to provide future therapeutic options.
authors.affiliation: Department of Child Health, School of Clinical Sciences, University of Nottingham, Nottingham, UK. matthew.hurley@nottingham.ac.uk.
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Hurley
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Forrester
authors.forename: Alan R
authors.initials: AR
authors.lastname: Smyth
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D017024:Chemotherapy, Adjuvant; D003550:Cystic Fibrosis / Q000150:complications*; D005737:Garlic; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic; D014815:Vitamins / Q000627:therapeutic use; D015032:Zinc / Q000008:administration & dosage; D019207:beta Carotene / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D014815:Vitamins; D019207:beta Carotene; D015032:Zinc