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Next steps on managing pulmonary exacerbations: Is the future less, shorter and or more targeted treatments?

  • Daniel J Smith
    Affiliations
    Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Australia

    Faculty of Medicine, The University of Queensland, Brisbane, Australia
    Search for articles by this author
  • Scott C Bell
    Correspondence
    Corresponding author.
    Affiliations
    Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Australia

    Faculty of Medicine, The University of Queensland, Brisbane, Australia

    Translational Research Institute, Brisbane, Australia
    Search for articles by this author
Published:August 27, 2022DOI:https://doi.org/10.1016/j.jcf.2022.08.015
      Pulmonary exacerbations (PEx) are a major cause of longitudinal lung function decline, morbidity and contribute to mortality in people with cystic fibrosis (CF)[
      • Aaron S.D.
      • Stephenson A.L.
      • Cameron D.W.
      • Whitmore G.A.
      A statistical model to predict one-year risk of death in patients with cystic fibrosis.
      ,
      • Britto M.T.
      • Kotagal U.R.
      • Hornung R.W.
      • Atherton H.D.
      • Tsevat J.
      • Wilmott R.W.
      Impact of recent pulmonary exacerbations on quality of life in patients with cystic fibrosis.
      ,
      • Waters V.
      • Stanojevic S.
      • Atenafu E.G.
      • Lu A.
      • Yau Y.
      • Tullis E.
      • et al.
      Effect of pulmonary exacerbations on long-term lung function decline in cystic fibrosis.
      ]. Despite universal recognition within the CF community of the importance of treating exacerbations effectively, there remains a paucity of high-quality evidence to guide basic treatment decisions, including which antibiotics to prescribe, in what combination and for how long? Consequently, PEx treatment is influenced by expert opinion and a dogma of the prescription of prolonged, multi-drug antibiotic regimens persist, driven by clinician and consumer fears of the negative impact of insufficient treatment.
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