Optimal treatment of the underlying aetiology is the most effective antimicrobial stewardship for chronic respiratory disease: a lesson learned from cystic fibrosis

The increasing occurrence of antimicrobial resistance in bacterial infections has emerged as one of the biggest threats to global health. Antimicrobial stewardship (AMS) programmes have grown rapidly [1, 2] over recent decades due to increasing evidence of their effect on the quality of medical care, by reducing adverse outcomes, bacterial resistance, drug-related toxicity and secondary infections [3]. Furthermore, they play a crucial role in reducing community resistance rates. National surveillance programmes of antimicrobial resistance providing yearly reports and interactive data platforms are well developed in most high-income countries. In low- and middle-income countries, major gaps exist, ranging from limited expertise, infrastructure, investment and access to antimicrobials, and lack of microbiological diagnostic capabilities [4]. AMS in chronic lung disease can be challenging. Causal treatment of treatable traits may be the most successful AMS strategy for patients with any chronic pulmonary disease and should be brought into focus. https://bit.ly/3ptrmV8