Much of the improvement in the survival of individuals with
cystic fibrosis (CF) is due to advancements in antimicrobial treatments. New aerosolized
antibiotic formulations have recently been introduced (such as inhaled
aztreonam), and others are in development (inhaled
levofloxacin and liposomal
amikacin). Licensed dry
powder formulations include
tobramycin inhalation
powder and dry
powder colistimethate (available in Europe). Although inhaled
antibiotics have the advantage of being able to deliver high intrapulmonary concentrations of drug, antimicrobial resistance can still develop and is a concern in CF. Antimicrobial resistance might be mitigated by using non-
antibiotic treatments,
antibiotic adjuvants, which have activity against bacteria. Examples include agents such as
gallium,
antimicrobial peptides and anti-biofilm compounds such as
alginate oligosaccharides (OligoG) and garlic. Vaccination strategies and antibody
therapy (
IgY) against Pseudomonas aeruginosa have also been attempted to prevent initial
infection with this organism in CF. Although aggressive and long-term use of
antibiotics has been crucial in slowing lung function decline and improving survival in people with CF, it has added a significant burden of care and associated toxicities in these individuals. Careful surveillance and the use of preventative strategies for
antibiotic related toxicity (such as nephrotoxicity and
ototoxicity) are essential. Continued development of effective
antimicrobial agents that can function in the conditions encountered in the CF lung, such as against bacterial biofilm growth and under anaerobic conditions, is needed.