Please note: While some information will still be current in a year, other information may already be out of date in three months time. If you are in any doubt, please feel free to ask.

infant cf treatment with colistin and food diversification

Dear doctors,

My 4 months old daughter has been diagnosed with cf one month ago.

I would kindly like to ask for your opinion for the following:
-she cultured positive the second time with E-coli in a tracheal aspirate. We tried to eradicate with inhaled gentamicin (5 days) and oral biseptol (3 days) for the first time without any success . Now her doctor recommended inhaled Colistin for one month.
1.Is this current procedure for cf infants to be recommended Colistin? Sounds agressive. I am not convinced of the need for this particular case, therefore my concern. E-coli in our case is very sensitve to a lot of other antibiotics on the antibiogram.
2.Is e-coli dangerous, does it predict future contamination with Pseudomonas Aeruginosa as SA does?

Thank you,
Ana Toma

Dear Ana Toma,
E. coli is a typical bacterium of the bowel. Most representatives of this species are not illness causing, however numerous different illness causing strains also exist. E. coli belongs to the most important causing agents of human infectious diseases. In CF patients, E. coli is one of the rather more seldom germs that can colonize the airways. However, the question remains and is not clear, if the finding and colonization of E. coli in the airways of CF patients is a clear pathogenicity and needs treatment in gneral, chronic colonization is also possible. Therefore I did not find any hints in the literature, that E. coli predicts a future colonization with Pseudomonas aeruginosa. However, if there are any clinical signs of exacerbation, the situation is different and a treatment is clearly necessary. Unfortunately, we cannot make a statement about the necessity of a treatment of the E. coli germ in the airways of your daughter, as we do not know her case personally and her clinical situation. This remains the decision of the physicians in charge at the CF center as they have all the results and findings of your daughter.
If treatment should be necessary, it should be done according to the antibiotic resistance testing; the idea behind the usage of inhalative antibiotics is to avoid the “systemic route” and so to have a high concentration of antibiotics in the airways where the germ has to be faught and a low concentration in the blood to have the side effects as small as possible. Sometimes, however, a combination of oral and inhalative antibiotics is necessary. Colistin is an inhalative antibiotic that has been used safely for decades in the treatment of CF and can be used even in children under 2 years of age. However, the decision if and what kind of treatment is necessary for your daughter can only be made by the physicians in charge as many factors in the clinical history of your daughter play a role in here.
Best regards,
Dr. Daniela d’Alquen (Coordinator of the Central English Archive of ECORN-CF)
The answer is edited by: Laura Jenkins