antibiotic treatment

Question

My CF child has already had 5 Port-A-Caths (PAC), 4 of them were removed because of infectious problems. The last one was really the last one because all his vascular network was totally sclerosed. Unfortunately, this PAC has been moved accidently by his school teacher and it was also removed. During the last hospitalizations for bronchial infection, the surgeon has successfully put a picc (peripheral inserted central venous catheter) line. He’s now again hospitalized and an attempt to put a picc line was made 3 times at different sites. Because it was impossible, a peripheral vein was searched but with no success. The pediatrician doesn’t want to try again a treatment by a vascular way and proposes a new treatment, not yet validated. All the intravenous treatment is now inhaled with an e-Flow nebulizer. This is the listing of his antibiotics: ceftazidime, IV tobramycin, tobramycin for inhalation, colistin and by an oral route sulfamethoxazole and azitromycin. I am really anxious with such a treatment because we know that in cystic fibrosis intravenous antibiotics are the only treatments with the hope to cure. Do you have other solutions to propose? Thanks.

Answer

Hello and thanks for your question.
Antibiotics are an important part of the CF treatment. Even if no antibiotic is able “to cure” in CF, the aim of the treatment is at least to decrease the symptoms linked to the infection and its possible consequences. The choice of the antibiotic is based on several points: the kind of bacteria we have found, its sensibility to one or more antibiotics, the availability of this or these chosen antibiotics for a particular delivery route (oral, intravenous or inhaled), the level of scientifically proven efficacy of the treatment. In some cases such a choice may also depend on the professional or scholar obligations of the patient, on the vascular network as in your child, etc. Our possibilities of antibiotic choice are still more multiple as some antibiotics are of similar efficacy administered by an oral and/or inhaled route as by an intravenous route (sulfamethoxazole or inhaled tobramycin for instance). Sometimes the choice is more restricitive or complex and may conduct, as in your case, to a less classical treatment. Therefore the clinical efficacy will be the best witness of the treatment interest.
I hope to have responded to your question.
With my best regards,
Prof Jean-Christophe Dubus

26.03.2013