CFDB - Cystic Fibrosis DataBase

Cochrane Database of Systematic Reviews - Cochrane Review

Treatment for chronic methicillin‐sensitive Staphylococcus aureus pulmonary infection in people with cystic fibrosis

Study design (if review, criteria of inclusion for studies)

Randomised controlled trials (RCTs) and quasi-RCTs


Children and adults with CF and confirmed microbiologic evidence of S. aureus (MSSA strains only) in clinically relevant CF respiratory cultures at least three times over a 12-month period or more such that 50% of the cultures in a year are positive for MSSA prior to enrolment into the trial.


Any combinations of topical, inhaled, oral or intravenous (IV) antimicrobials used with the objective of suppressive therapy for chronic infection with S. aureus compared with placebo or no treatment.

Outcome measures

Primary outcomes 1. Sputum clearance of S. aureus 2. Pulmonary function tests i) forced expiratory volume at one second (FEV1) per cent (%) predicted or litres ii) forced vital capacity (FVC) % predicted or litres iii) any other validated measures of pulmonary function 3. Adverse events i) emergence of resistant organisms ii) other adverse events such as rashes, Stevens-Johnson type reactions, photosensitivity, tooth discolouration etc. Secondary outcomes 1. Frequency of respiratory exacerbations 2. Hospital admissions secondary to respiratory exacerbation 3. School or work attendance 4. Quality of life (QoL) 5. Mortality 6. Nutritional parameters 7. Chest radiography scores 8. Days of IV antibiotics 9. New isolation of bacteria i) P. aeruginosa ii) MRSA iii) other

Main results

The searches identified 58 trials, but none were eligible for inclusion in the current version of this review.

Authors' conclusions

No randomised controlled trials were identified which met the inclusion criteria for this review. Although methicillin‐sensitive Staphylococcus aureus is an important and common cause of lung infection in people with cystic fibrosis, there is no agreement on how best to treat long‐term infection. The review highlights the need to organise well‐designed trials that can provide evidence to support the best management strategy for chronic methicillin‐sensitive Staphylococcus aureus infection in people with cystic fibrosis.

Keywords: Anti-Bacterial Agents; Bacterial Infections; Infection; pharmacological_intervention; Respiratory Tract Diseases; Respiratory Tract Infections; Staphylococcus aureus; Continuous; Inhalation OR nebulised; Intermittent; Intravenous; Oral; Ampicillin; carbenicillin; Cephalexin; Ciprofloxacin; Clavulanic Acid; clindamycin; Cloxacillin; Cotrimoxazole; Dicloxacillin; Erythromycin; flucloxacillin; Penicillins; Cephalosporins; Quinolones; Lincosamides; Sulfonamides; Macrolides;