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Pseudomonas Colonisation — SCE Infectious Diseases MCQ

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ModerateRespiratory InfectionPseudomonas ColonisationSCE Infectious Diseases

A 55-year-old man with COPD and recurrent infective exacerbations is colonised with Pseudomonas aeruginosa. He has had 4 exacerbations in the past year, each requiring IV antibiotics. Sputum consistently grows Pseudomonas. What is the evidence-based intervention to reduce exacerbation frequency?

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Correct answer: B — Long-term inhaled Colistin or Tobramycin nebulisation

For patients with bronchiectasis/COPD and chronic Pseudomonas colonisation with frequent exacerbations, long-term inhaled anti-pseudomonal antibiotics (nebulised Colistin or Tobramycin) are recommended to reduce exacerbation frequency and bacterial load. This is based on evidence from bronchiectasis guidelines (BTS 2019). Long-term oral macrolides (Azithromycin) may additionally reduce exacerbations through immunomodulatory effects but are not specifically anti-pseudomonal. Continuous oral Ciprofloxacin risks resistance development.

Reference: BTS 2019 – Bronchiectasis guidelines; NICE NG117 2018 – Bronchiectasis