title: Clinical implications of Pseudomonas aeruginosa location in the lungs of patients with cystic fibrosis.
abstract: OBJECTIVE
  Pseudomonas aeruginosa is the leading cause of lung infection in patients with cystic fibrosis (CF) and is associated with significant morbidity and mortality. Antibiotics are regarded as the foundational pharmacological treatment for the suppressive management of chronic P. aeruginosa infections and to eradicate the first infection by P. aeruginosa. Inhalation remains a preferred route for drug administration, providing direct access to the site of infection while minimizing systemic side effects. Effective suppressive management of P. aeruginosa infections, however, requires an understanding of the location of the bacteria in the lungs and consideration of the factors that could limit access of the inhaled antibiotic to the infected area. This review provides a systematic assessment of the scientific literature to gain insight into the location of P. aeruginosa in the lungs of patients with CF and its clinical implications. The characteristics of antibiotic inhalation systems are also discussed in this context.
  
  
  METHODS
  We reviewed evidence-based literature from both human and animal studies in which P. aeruginosa lung location was reported. Relevant publications were identified through a screening strategy and summarized by reported P. aeruginosa location.
  
  
  CONCLUSIONS
  Most areas of the conductive and respiratory zones of the lungs are susceptible to P. aeruginosa colonization. Deposition of an inhaled antibiotic is dependent on the device and formulation characteristics, as well as the ability of the patient to generate sufficient inhaled volume. As patients with CF often experience a decline in lung function, the challenge is to ensure that the inhaled antibiotic can be delivered throughout the bronchial tree.
  
  
  CONCLUSIONS
  An effective drug delivery system that can target P. aeruginosa in both the respiratory and conductive zones is required. The chosen inhalation device should also offer a drug formulation that can be quickly and effectively delivered to specific lung locations, with minimal inspiratory effort from the patient.
authors.affiliation: Northern Ireland Public Health Laboratory, Department of Bacteriology, Belfast City Hospital, Belfast, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Moore
authors.affiliation: Respiratory Department, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
authors.forename: P
authors.initials: P
authors.lastname: Mastoridis
mesh_terms: D000280:Administration, Inhalation; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000150:complications* / Q000382:microbiology; D006801:Humans; D008168:Lung / Q000382:microbiology; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: 
  Pseudomonas aeruginosa
  ; conductive zone; cystic fibrosis; lung infection; lung location; respiratory zone