fdixon …… I too have a pseudomonas problem. I've never had a report that said 3+, 4+ or anything like that. The sputum tests I do just say "many" -- so I don't know how that falls into your category. I've been on toby for over a year and am not getting rid of them. I am discouraged about that too. I have difficulty taking it due to shortness of breath but am now doing two weeks on and two weeks off. I cough all the time -- never clear -- always green and have no trouble coughing it up whether or not I do anything. I do nebulize 3% saline twice daily and albuterol twice daily plus the toby. I'm wondering if anyone has any other med that has helped to rid pseudomonas. My doctor is with Mayo's in Rochester (for what that's worth). Appreciate all comments concerning pseudomonas.