Lenoir G, de Montalembert M
Département de pédiatrie, hôpital Necker-Enfants-Malades, Paris.
Rev Prat. 1990 Jun 11;40(17):1559-65.
In cystic fibrosis infection is localized to the bronchi and self-perpetuated by a disorder of mucociliary clearance. At a certain stage of the disease infection is caused by Pseudomonas aeruginosa (PA), and the patient cannot get rid of it as cystic fibrosis reduces his defence mechanisms against this organism, a naturally weak pathogen. The presence and significance of persistent bronchial PA infection result from complex phenomena which have been summarized as "an opportunistic organism in a host whose defences have been very peculiarly compromised". The toxicity of PA and the inappropriate inflammatory response of the host concur to create permanent alveolar lesions which are gradually spreading out. The effectiveness of antibiotics depends on the organism and its resistance, on pharmacokinetic factors bringing the drug in situ and on local conditions of redox, physico-chemical environment and nutrition. Other factors intervene more roughly, including patient's age, liver impairment, lung anatomy (excluded areas), general malnutrition and vitamin deficiencies. Thus, the part played by other treatments in the antibiotic therapy of cystic fibrosis can no longer be ignored, just as it is no longer sensible to limit the use of antibiotics to obvious infections. To evaluate the effectiveness of antibiotics is not easy, but it can be demonstrated beyond any doubt when the above mentioned factors are taken into account. The use of antibiotics creates practical problems relating to their cost, their dosage, their side-effects, the adequacy of therapeutic infrastructures and, above all, it raises the question of short- and long-term changes in microbial ecology.
在囊性纤维化中，感染局限于支气管，并因黏液纤毛清除功能紊乱而持续存在。在疾病的某个阶段，感染由铜绿假单胞菌（PA）引起，由于囊性纤维化降低了患者对这种原本致病性较弱的病原体的防御机制，患者无法清除该病菌。持续性支气管PA感染的存在及其意义源于复杂的现象，这些现象被总结为“在防御机制极为特殊地受损的宿主中的一种机会性生物体”。PA的毒性和宿主不适当的炎症反应共同导致永久性肺泡病变，并逐渐扩散。抗生素的有效性取决于病原体及其耐药性、将药物送达感染部位的药代动力学因素以及局部的氧化还原、物理化学环境和营养状况。其他因素的干预更为显著，包括患者年龄、肝功能损害、肺部解剖结构（排除区域）、全身营养不良和维生素缺乏。因此，其他治疗方法在囊性纤维化抗生素治疗中所起的作用再也不能被忽视，正如将抗生素的使用局限于明显感染的做法不再明智一样。评估抗生素的有效性并不容易，但如果考虑到上述因素，其有效性是毋庸置疑的。抗生素的使用带来了与成本、剂量、副作用、治疗基础设施的充足性相关的实际问题，最重要的是，它引发了微生物生态短期和长期变化的问题。
