[Pseudomonas aeruginosa and cystic fibrosis: non-antibiotic strategy]

Abstract

The Pseudomonas aeruginosa bronchopulmonary infection is, when chronical, a poor prognosis factor for cystic fibrosis children. The higher life expectancy is partly linked to the progresses of the antipseudomonal antibiotherapy: treatment modulated to the stage of infection; possible use of nebulized and oral (ciprofloxacin) antibiotics. But the antipseudomonal strategy does not limit to the antibiotherapy. The preventive approach includes: preservation of a good nutritional status; daily chest physiotherapy with combined use of aerosolized recombinant human DNase for more than 5 years old children with significative bronchorrea; early anti-infammatory treatment with inhaled corticosteroids, despite a poor efficacy proof level; hygiene measures to reduce the environmental and domestic reservoirs and to avoid nosocomial infections. The development of vaccines for the prevention of P. aeruginosa infection is a promising way but stays in the field of clinical research. In case of chronical infection, long-term macrolids reduce the virulence factors expression of the bacteria, leading to antibiofilm properties in spite of subinhibitory concentrations.