The difficulties of treating infection in adults with cystic fibrosis.

The treatment of pulmonary infection in the adult with cystic fibrosis (CF) is palliative rather than curative. This review discusses the following management problems: infection with Pseudomonas aeruginosa and the associated strong self-damaging host responses; Pseudomonas cepacia; the underestimated role of viruses in causing progressive lung damage; and the difficulty of treating infection when complicated by medical problems, such as diabetes, haemoptysis, pneumothorax and pregnancy. Also considered, are the effect of poor compliance upon treatment and the expertise that is required to keep alive the preterminal patient actively listed for heart lung transplantation.