Treatment of pulmonary exacerbations in cystic fibrosis

Pulmonary exacerbations have very important consequences in cystic fibrosis (CF), both in terms of current morbidity as well as implications for long term morbidity and mortality. Even though there is no universally agreed definition of pulmonary exacerbation, prompt and aggressive treatment with a multidisciplinary approach is recommended. Maintenance treatments reduce the risk of exacerbations. Antibiotics should be targeted against the common CF bacteria and these can be given orally, although i.v. antibiotics will be required for ongoing symptoms or severe exacerbations. The evidence base for recommendations regarding the optimal regimens, route and frequency of administration of antibiotics, location, and duration of i.v. antibiotic treatment will be discussed. Management of comorbidities, like poor nutrition and diabetes, is critical in improving outcomes.