The most common regimen is the combination of an aminoglycoside with a penicillin or cephalosporin for a three-week course. Fewer options exist for Pseudomonas aeruginosa infections. The U.S. CF foundation recommends quinolones for patients of all ages for this infection. Inhaled or aerosolized anti-pseudomonal therapy has been used for many years for early treatment or suppressive therapy. They achieve high local concentration with minimal risk of systemic toxicity.
Clinical data show that high but variable sputum concentrations are achieved.
This is associated with significant sustained improvement in lung function, decreased use of anti-pseudomonal antibiotics, and decreased hospitalizations. No hearing loss or renal toxicity is associated with the use of tobramycin, and resistance after 12 months of therapy has been shown to be no more frequent than with placebo. The final therapeutic consideration for the CF patient is lung transplantation. As experience grows, this has been associated with greater success and longer survival rates. Unfortunately, this therapy remains greatly limited due to donor availability.