title: Cystic Fibrosis Foundation pulmonary guideline. pharmacologic approaches to prevention and eradication of initial Pseudomonas aeruginosa infection.
abstract: METHODS
  The Cystic Fibrosis (CF) Foundation developed clinical care guidelines for the prevention of Pseudomonas aeruginosa infection, the treatment of initial P. aeruginosa infection, and the use of bronchoscopy to obtain routine airway cultures in individuals with CF.
  
  
  METHODS
  A multidisciplinary committee developed questions about the prevention and treatment of initial P. aeruginosa infection and the use of bronchoscopy to obtain routine airway cultures. The outcome measure of interest was cultures without P. aeruginosa growth. Systematic reviews of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were conducted in May 2012 and August 2013. Searches combined controlled vocabulary terms and text words for CF and terms relevant to each question. The entire committee reviewed the evidence, and final recommendation statements were graded using the U.S. Preventive Services Task Force system. Recommendation 1: The CF Foundation strongly recommends inhaled antibiotic therapy for the treatment of initial or new growth of P. aeruginosa from an airway culture (certainty of net benefit, high; estimate of net benefit, substantial; grade of recommendation, A). The favored antibiotic regimen is inhaled tobramycin (300 mg twice daily) for 28 days. Recommendation 2: The CF Foundation recommends against the use of prophylactic antipseudomonal antibiotics to prevent the acquisition P. aeruginosa (certainty of net benefit, moderate; estimate of net benefit, zero; grade of recommendation, D). Recommendation 3: The CF Foundation recommends routine oropharyngeal cultures rather than bronchoalveolar lavage cultures obtained by bronchoscopy in individuals with CF who cannot expectorate sputum to determine if they are infected with P. aeruginosa (certainty of net benefit, moderate; estimate of net benefit, moderate; grade of recommendation, B).
authors.affiliation: 1 Department of Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mogayzel
authors.forename: Edward T
authors.initials: ET
authors.lastname: Naureckas
authors.forename: Karen A
authors.initials: KA
authors.lastname: Robinson
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brady
authors.forename: Margaret
authors.initials: M
authors.lastname: Guill
authors.forename: Thomas
authors.initials: T
authors.lastname: Lahiri
authors.forename: Lisa
authors.initials: L
authors.lastname: Lubsch
authors.forename: Jane
authors.initials: J
authors.lastname: Matsui
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Oermann
authors.forename: Felix
authors.initials: F
authors.lastname: Ratjen
authors.forename: Margaret
authors.initials: M
authors.lastname: Rosenfeld
authors.forename: Richard H
authors.initials: RH
authors.lastname: Simon
authors.forename: Leslie
authors.initials: L
authors.lastname: Hazle
authors.forename: Kathy
authors.initials: K
authors.lastname: Sabadosa
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Marshall
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D035843:Biomedical Research; D003550:Cystic Fibrosis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D011552:Pseudomonas Infections / Q000209:etiology / Q000517:prevention & control*; D012955:Societies, Medical
chemical_list: D000900:Anti-Bacterial Agents
keywords: airway infection; antipseudomonal vaccine; bronchoscopy; inhaled antibiotics; oropharyngeal culture