This protocol applies to patients at high risk of exacerbations who also have chronic airway infection with Pseudomonas aeruginosa, and in whom the initial long-term antibiotic strategy — assessed over 12 months — has not achieved adequate reduction in exacerbation frequency.
High exacerbation risk with chronic Pseudomonas aeruginosa airway infection. High-risk status is defined by any one of:
The previous line offered either a long-term macrolide or a long-term inhaled antibiotic as first-line treatment, selected based on patient preference and an individualised risk assessment. After 12 months, the goal of reducing exacerbation frequency was not reached. This protocol defines the next clinical step.
The approach at this stage centres on reassessing the current long-term antibiotic strategy and considering a targeted change in therapeutic direction. The complete protocol specifies the available options and the criteria for selecting among them.
We recommend to offer long-term inhaled antibiotics to patients at high risk of exacerbations and chronic infection with P. aeruginosa despite standard care.
Patients at high risk of exacerbations include patients with a history of ≥2 exacerbations in the prior year OR ≥1 severe exacerbation OR 1 exacerbation plus severe daily symptoms.
Patients with P. aeruginosa may receive either a long-term macrolide or long-term inhaled antibiotic as first-line treatment, with the choice based on patient preference and an individualised assessment of risks.
DOI: 10.1183/13993003.01126-2025
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