Editing Cystic fibrosis (section)

===Antibiotics===
Many people with CF are on one or more antibiotics at all times, even when healthy, to [[Preventive healthcare|prophylactically]] suppress infection. The choice of antibiotics for cystic fibrosis depends on the specific bacteria that are causing the infection, as well as the patient's age, weight, and other medical conditions.{{Citation needed|date=July 2023}} Antibiotics are necessary whenever pneumonia is suspected or a noticeable decline in lung function is seen, and are usually chosen based on the results of a sputum analysis and the person's past response.{{Citation needed|date=July 2023}} This prolonged therapy often necessitates hospitalization and insertion of a more permanent [[Heparin lock|IV]] such as a [[peripherally inserted central catheter]] or [[Port-a-Cath]]. Inhaled therapy with antibiotics such as [[tobramycin]], [[colistin]], and [[aztreonam]] is often given for months at a time to improve lung function by impeding the growth of colonized bacteria.<ref name="pmid11568993">{{cite journal | vauthors = Pai VB, Nahata MC | title = Efficacy and safety of aerosolized tobramycin in cystic fibrosis | journal = Pediatric Pulmonology | volume = 32 | issue = 4 | pages = 314–327 | date = October 2001 | pmid = 11568993 | doi = 10.1002/ppul.1125 | s2cid = 30108514 }}</ref><ref name="pmid15463883">{{cite journal | vauthors = Westerman EM, Le Brun PP, Touw DJ, Frijlink HW, Heijerman HG | title = Effect of nebulized colistin sulphate and colistin sulphomethate on lung function in patients with cystic fibrosis: a pilot study | journal = Journal of Cystic Fibrosis | volume = 3 | issue = 1 | pages = 23–28 | date = March 2004 | pmid = 15463883 | doi = 10.1016/j.jcf.2003.12.005 | doi-access = free }}</ref><ref name="pmid18658109">{{cite journal | vauthors = McCoy KS, Quittner AL, Oermann CM, Gibson RL, Retsch-Bogart GZ, Montgomery AB | title = Inhaled aztreonam lysine for chronic airway Pseudomonas aeruginosa in cystic fibrosis | journal = American Journal of Respiratory and Critical Care Medicine | volume = 178 | issue = 9 | pages = 921–928 | date = November 2008 | pmid = 18658109 | pmc = 2577727 | doi = 10.1164/rccm.200712-1804OC }}</ref> Inhaled antibiotic therapy helps lung function by fighting infection, but also has significant drawbacks such as development of antibiotic resistance, tinnitus, and changes in the voice.<ref name="pmid21412868">{{cite journal | vauthors = Ryan G, Singh M, Dwan K | title = Inhaled antibiotics for long-term therapy in cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD001021 | date = March 2011 | pmid = 21412868 | doi = 10.1002/14651858.CD001021.pub2 }}</ref> Inhaled [[levofloxacin]] may be used to treat ''[[Pseudomonas aeruginosa]]'' in people with cystic fibrosis who are infected.<ref name="European Medicines Agency">{{cite web|url=http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002789/human_med_001846.jsp&mid=WC0b01ac058001d124|title=Quinsair (levofloxacin)|website=European Medicines Agency|url-status=live|archive-url=https://web.archive.org/web/20161226220044/http://www.ema.europa.eu/ema/index.jsp?curl=pages%2Fmedicines%2Fhuman%2Fmedicines%2F002789%2Fhuman_med_001846.jsp&mid=WC0b01ac058001d124|archive-date=26 December 2016|access-date=26 December 2016}}</ref>

Antibiotics by mouth such as ciprofloxacin or [[azithromycin]] are given to help prevent infection or to control ongoing infection.<ref name="pmid15752679">{{cite journal | vauthors = Hansen CR, Pressler T, Koch C, Høiby N | title = Long-term azitromycin treatment of cystic fibrosis patients with chronic Pseudomonas aeruginosa infection; an observational cohort study | journal = Journal of Cystic Fibrosis | volume = 4 | issue = 1 | pages = 35–40 | date = March 2005 | pmid = 15752679 | doi = 10.1016/j.jcf.2004.09.001 | doi-access = free }}</ref> The [[aminoglycoside]] antibiotics (e.g. tobramycin) used can cause [[Ototoxicity|hearing loss]], damage to the [[Vestibular system|balance system]] in the [[inner ear]] or kidney failure with long-term use.<ref name="pmid12623858">{{cite journal | vauthors = Tan KH, Mulheran M, Knox AJ, Smyth AR | title = Aminoglycoside prescribing and surveillance in cystic fibrosis | journal = American Journal of Respiratory and Critical Care Medicine | volume = 167 | issue = 6 | pages = 819–823 | date = March 2003 | pmid = 12623858 | doi = 10.1164/rccm.200109-012CC }}</ref> To prevent these [[Adverse drug reaction|side-effect]]s, the amount of antibiotics in the blood is routinely measured and adjusted accordingly.<ref name="Fact Sheet-2020">{{Cite web |title=Antibiotic resistance |url=https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance |access-date=24 June 2022 |publisher=World Health Organization |date=31 July 2020 |work=Fact Sheet}}</ref>

Currently, no reliable clinical trial evidence shows the effectiveness of antibiotics for pulmonary exacerbations in people with cystic fibrosis and ''Burkholderia cepacia'' complex<ref name="pmid32239690">{{cite journal | vauthors = Lord R, Jones AM, Horsley A | title = Antibiotic treatment for Burkholderia cepacia complex in people with cystic fibrosis experiencing a pulmonary exacerbation | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 4 | pages = CD009529 | date = April 2020 | pmid = 32239690 | pmc = 7117566 | doi = 10.1002/14651858.CD009529.pub4 }}</ref> or for the use of antibiotics to treat [[nontuberculous mycobacteria]] in people with CF.<ref name="pmid32521055">{{cite journal | vauthors = Waters V, Ratjen F | title = Antibiotic treatment for nontuberculous mycobacteria lung infection in people with cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 6 | issue = 6 | pages = CD010004 | date = June 2020 | pmid = 32521055 | pmc = 7389742 | doi = 10.1002/14651858.CD010004.pub5 }}</ref>

==== ''Pseudomonas aeruginosa'' ====
The early management of ''Pseudomonas aeruginosa'' infection is usually suggested using nebulised antibiotics with or without oral antibiotics to remove the bacteria from the person's airways for some time.<ref name="pmid37268599">{{cite journal | vauthors = Langton Hewer SC, Smith S, Rowbotham NJ, Yule A, Smyth AR | title = Antibiotic strategies for eradicating Pseudomonas aeruginosa in people with cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 6 | pages = CD004197 | date = June 2023 | pmid = 37268599 | pmc = 10237531 | doi = 10.1002/14651858.CD004197.pub6 }}</ref> When choosing antibiotics to treat lung infections caused by ''Pseudomonas aeruginosa'' in people with cystic fibrosis, it is still unclear whether the choice of antibiotics should be based on the results of testing antibiotics separately (one at a time) or in combination with each other.<ref name="pmid32412092">{{cite journal | vauthors = Smith S, Ratjen F, Remmington T, Waters V | title = Combination antimicrobial susceptibility testing for acute exacerbations in chronic infection of Pseudomonas aeruginosa in cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 5 | pages = CD006961 | date = May 2020 | pmid = 32412092 | pmc = 7387858 | doi = 10.1002/14651858.CD006961.pub5 }}</ref> It is also unclear if these treatment approaches for the ''Pseudomonas aeruginosa'' infection improve the person's quality of life or lifespan.<ref name="pmid37268599" /> The negative side effects of antibiotics for this infection are also poorly studied.<ref name="pmid37268599" /> Intravenous antibiotic therapy to treat ''Pseudomonas aeruginosa'' infections is not any better than antibiotics taken orally.<ref name="pmid37268599" />

==== Methicillin-resistant ''Staphylococcus aureus'' ====
[[Methicillin-resistant Staphylococcus aureus|Methicillin-resistant ''Staphylococcus aureus'']] (MRSA) infections can be dangerous for people with cystic fibrosis and can worsen lung damage leading to more rapid decline. Early antibiotic treatment is standard; however, further research is needed to determine longer-term effects and benefits (3–6 months after the treatment or longer) and survival rates associated with different treatment options.<ref name="pmid36511181">{{cite journal | vauthors = Lo DK, Muhlebach MS, Smyth AR | title = Interventions for the eradication of meticillin-resistant Staphylococcus aureus (MRSA) in people with cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 12 | issue = 12 | pages = CD009650 | date = December 2022 | pmid = 36511181 | pmc = 9745639 | doi = 10.1002/14651858.CD009650.pub5 | collaboration = Cochrane Cystic Fibrosis and Genetic Disorders Group }}</ref>

==== Antibiotic adjuvant therapy ====
Factors related to antibiotic use, the chronicity of the disease, and the emergence of resistant bacteria demand more exploration for different strategies such as antibiotic [[adjuvant]] therapy.<ref name="pmid32671834">{{cite journal | vauthors = Hurley MN, Smith S, Forrester DL, Smyth AR | title = Antibiotic adjuvant therapy for pulmonary infection in cystic fibrosis | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | pages = CD008037 | date = July 2020 | pmid = 32671834 | pmc = 8407502 | doi = 10.1002/14651858.CD008037.pub4 }}</ref> Antibiotic adjuvant therapy refers to therapeutic approaches that aim to improve the action of antibiotics such a pharmaceutical agents or supplements that impact the virulence of the bacterium or that change the susceptibility of the organism to the antibiotic so that the antibiotics are more effective.<ref name="pmid32671834" /> There is no strong evidence to recommend specific antibiotic adjuvant therapies such as [[Β-Carotene|β-carotene]], [[nitric oxide]], [[zinc supplements]], or KB001-A.<ref name="pmid32671834" />