Smith A L, Ramsey B, Redding G, Haas J
Department of Pediatrics, University of Washington, Seattle 98105.
Acta Paediatr Scand Suppl. 1989;363:31-6. doi: 10.1111/apa.1989.78.s363.31.
In symptomatic patients with cystic fibrosis, the recovery of bacteria in an inflammatory exudate from the lower respiratory tract is strong evidence of endobronchitis. It is not known when this chronic infection begins, the etiologic agents during infancy or the mechanism of evolution from Haemophilus influenzae and Staphylococcus aureus to Pseudomonas aeruginosa. Antibiotic administration to "suppress" the infection in relatively well patients is an unproven benefit. During an exacerbation of bronchitis, administration of appropriate antibiotics decreases sputum bacterial density and is accompanied by decreased amounts of indicators of inflammation in sputum: pulmonary function improves, particularly that reflecting medium to small airway status. In the future aggressive diagnostic procedures will be followed by therapeutic and prophylactic antibiotic administration conducted in a manner to minimize emergence of antibiotic-resistant bacteria. Adjunctive therapy, to minimize those aspects of the host response which inflict lung damage, will become standard.
在有症状的囊性纤维化患者中，从下呼吸道炎性渗出物中培养出细菌是细支气管炎的有力证据。目前尚不清楚这种慢性感染何时开始，婴儿期的病原体是什么，以及从流感嗜血杆菌和金黄色葡萄球菌演变为铜绿假单胞菌的机制。对病情相对较好的患者使用抗生素“抑制”感染，其益处尚未得到证实。在支气管炎加重期间，使用适当的抗生素可降低痰液细菌密度，并伴有痰液中炎症指标的减少：肺功能改善，尤其是反映中小气道状况的肺功能。未来，在积极的诊断程序之后，将进行治疗性和预防性抗生素给药，以尽量减少耐药菌的出现。辅助治疗将成为标准，以尽量减少宿主反应中对肺部造成损害的那些方面。
