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Worsening of the lung function due to tobramycin inhalation
Dear expert team, I have been diagnosed (23, CF) with Pseudomonas aeruginosa lately for the first time. We decided to eradicate with 3x750mg ciprofloxacin p.o. over 3 weeks and inhalation with 2x300mg tobramycin with a 28-days-change with 2x2 Mio. I.U. Colistin over 6 months altogether. My general condition is not really well already for months - even before the finding of Pseudomonas - but also not really bad, either. Even after only 3 days of ciprofloxacin, I felt an improvement. I started on the 4th day additionally with the inhalation of tobramycin for the first time, whereupon the improvement disappeared nearly immediately and for the moment the same indifferent state as before appeared. During the whole time of inhalation with tobramycin I had nearly every day blood in the sputum, if only miminal amounts. According to the package insert possible side effects of tobramycin are a reduction of FEV1 as well as coughing blood. I maintained the therapy however like this and after there was no change at all for one week, finally again an improvement appeared. In the meantime I feel as good as I did not for years and the PA could not be detected in the last sputum. During the inhalation with Colistin I did not have any problems at all, shortly the second cycle of inhalation with tobramycin should begin. I am now worried, that because of the tobramycin my lung function decreases again to a fair to bad condition, as this time the respective antagonist in the form of ciprofloxacin is missing, which compensated the seemingly caused worsening of the lung function via tobramycin. Now I am thinking about it, how I should react, in case I realize that via the inhalation of Tobramycin my lung function gets indeed worse again. Should I stop the therapy and try to keep the good condition as long as possible, but risk however that the PA recolonizes in the short runs? Or should I continue the therapy for the 6 months even if I feel worse, then, but have higher chances that the PA does not recolonize for now? Many thanks for your advice in advance, Yours sincerely,
09.02.2011
Twins
If a twin suffers from CF, is the other child also ill or can it be totally healthy?
09.02.2011
Side effects after long-term therapy with azithromycin??
Hello, my 12-year-old son is chronically colonized with Pseudomonas aeruginosa (PSA) for two years. Since 6/2010 two times capsule-forming germs have been found in the throat swab. Since then he takes additionally azithromycin 250mg every second day besides Colistin and DNAse. As this therapy is planned as a long-term therapy we ask ourselves: Which side-effects does the drug have (arthropathy of the joints? Colonization with Streptococci? Occurence of resistance?) ? Is there an alternative to this kind of PSA-therapy?? Many thanks for your feedback.
09.02.2011
Staphyloccocus aureus
Hello, our daughter (13 months) has been diagnosed with the germ Staphylococcus aureus in the throat swab. She has it - since her diagnose 10 months ago - now for the second time. Apart from the mucus she has, which she can cough out very well however, she has no symptoms of infection. We inhale two times a day with NaCl and salbutamol as well as ipratropium bromide. Our CF-center does not regard it as necessary to give an antibiotic. When the germ occured for the first time, however, the former physician of our center prescribed a cephalosporine. In the meantime there has been a change of the physician in charge. Is it now right that she does'nt take an antibiotic? Will she get rid of the germ again? Is this germ "dangerous"? How can she get this germ as we have no animals and she has had no contact with animals? I would be very pleased if you could answer the above mentioned questions. Many thanks for your efforts.
09.02.2011
Mutation
Hello My daughter has CF and is almost 4 years old. She is clearly pancreatic insufficient and has a rather moderate pulmonary impairment, (say Staphylococcus colonization, and started Pulmozyme 6 months ago) with mutations deltaF508 /1898 +1 G> A. I failed to get information from my CF Center about this mutation. I'd like to know what's its class and its exact function (CFTR production or not etc...) and whether other similar cases have been described. Thank you.
08.02.2011
Pseudomonas stutzeri in the lung
Dear ladies and gentlemen, I have been diagnosed lately with a colonization of the lung with Pseudomonas stutzeri. The investigation had been done due to cough with yellowish/putride sputum, in the meantime lasting for 8 months. The physician is of the opinion however, that my symptoms have nothing to do with the colonization of this germ. What kind of damage can this germ do in my lungs and which treatment would be appropriate? Best regards,
07.02.2011
Hygiene, the second [referring to "Hygiene" 10.01.2011]
Many thanks for your detailed answer. But to be honest. I do not understand how it can come to such differing statements concerning the occurence of MRSA: You say: the frequency of MRSA in the standard population is however much smaller as in hospitals and lies clearly under 1%. And the Paul Ehrlich Institute (Germany) talks about the by me mentioned numbers over 20%: http://www.p-e-g.org/aktuelles/141. Or does it mean if both numbers are true that in hospitals and old peopel's homes etc the frequency is so high that the mean of the population is 22%, even if the "standard population" (who however that is, then) is colonized only in 1% of cases? Probably the right question would be: how many MRSA-carrier do I meet in the bus or the fitness center? Again many thanks, also for your patience.
07.02.2011
cystic fibrosis and physiotherapy in babies
How can we do physio in babies? Ours is 12 months old and complains all the time
07.02.2011
Transmission of Pseudomonas
I am a parent of a child resident in an institution for children with cystic fibrosis and multiple disabilities with a section where there are children colonized with pseudomonas aeruginosa. What precautions should be taken when he attends common rooms ?
07.02.2011
Aerosols and contamination
Hello, My 7 years-old CF son is treated with nebulised RhDNase. He is using a disposable jet nebuliser (PortaNeb). Recently, 3 different bacteria have been found in high quantity in his sputum: Stenotrophomonas maltophilia, Rhizobium radiobacter, and Chryseobacterium indologenes. Fortunately, they have been eradicated, despite their resistance, with an oral treatment with ciprofloxacin and cotrimoxazole. On one hand, our CF Centre, thinking that these bacteria came from the nebuliser, has stopped the RhDNase treatment. From this date our son shows difficulties to expectorate and coughs more. On the other hand, people renting the nebuliser think that a microbial contamination from the nebuliser is impossible because their devices are systematically disinfected between rentals, because the device of my son was new, and because it was disposable. Moreover, I disinfected weekly the compressor with wipes impregnated with detergent product. At last, the hospital microbiologist (another one that the one of the CF centre), who is regularly in charge of the microbial evaluation of my son sputum, thinks that the 3 germs are environmental bacteria, found, like Pseudomonas aeruginosa, into the ground. These bacteria would be found in the more severe patients or in patients colonised with Staphylococcus aureus (my son is colonised since 18 months). She also said to me that Stenotrophomonas maltophilia and Rhizobium radiobacter were emerging bacteria in CF. She thinks that microbial contamination is not linked to the nebuliser, but maybe because of my son's practice to scratch the ground with his fingers (we are living in the country), and to bite one’s nails, even if his hands are regularly washed. I would know who to believe, knowing that the practitioner of the CF centre is not favourable to aerosols.
02.02.2011
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