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Therapy

Question
I've got a few questions:
My daughter is 12 years old, diagnosed with CF at 4 months of age. She's got isolated from spitum bacteria P. aeruginosa for 2 years and a half. Since then she's been ill more often and was treated by IV antibiotics (5 hospital stays from June 2007 till June 2008 In between the hospitalizations she was on oral antibiotics also), to clear the lungs infection.
A month ago they found in spitum the bacteria - Acinetobacter. Is it good to try therapy by Colistin inhalatory antibiotic? What is the standard protocol for it?
What is the treatment protocol with both inhalatory antibiotics - Colistin and и Tobi 300mg/5ml (tobramycin)? Is it better to take them both? Or shall we switch between them and in what time with what pause?
What follow-up tests must be run to see the effect?
We haven't tried yet none of these two antibiotics.

Thank you! Wish you health and luck!
Svetlana Atanasova - Bulgarian
email: atanasova.1972@abv.bg ; SKYPE: kreizi1972
Answer
Hello Svetlana
I will try to answer your question. Acinetobacter is an uncommon cause of infection in CF but is well recognised. Before treatment my advice would be that it should be confirmed in at least 2 sputum samples and there is reasonable evidence to support the use of inhaled Colistin. Colistin is probably better than Tobramycin as Acinetobacter is less likely to be resistant to Colistin. Colistin also has anti-pseudomonal effects and I would consider Colistin only rather than alternating with TOBI to be a reasaonble therapy. Follow-up tests will be re-culturing of antibiotics if it has been commenced.

No direct studies have been undertaken in CF but there is a useful Cochrane Review on nebulised Colistin for Nosocomial Acinetobacter Baumannii respiratory tract infection. Cochrane Systematic Reivews 2008, issue 3. This is currently a protocol but summarises the background well and may provide stronger information in the future.

I hope this addresses your question
Regards

Stuart Elborn
08.09.2008
The answer is edited by: Prof Stuart Elborn