Prophylactic antibiotics in cystic fibrosis: a conviction without evidence?

Pulmonary infection with Staphylococcus aureus occurs in young children with cystic fibrosis, and may contribute to the cycle of infection, inflammation, and destruction of lung tissue which leads to bronchiectasis. Practice guidelines in North America and the UK differ greatly with regard to the advice given on prescribing prophylactic antistaphylococcal antibiotics to young children with cystic fibrosis. This article reviews the evidence behind these guidelines, and suggests a pragmatic approach to clinical practice. The implications for research are also discussed, and suggestions are made for clinical trials to inform future guidelines.