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Bugs !!

Question
My 16 yr old son has CF. He has been growing Micobacterium Abscessus for a couple of years and is on intensive eradication therapy (Amikacin nebs, Clarithromycin) He recently also grew Scedosporius - and has now cultured Pseudomonas (again) so is on eradication therapy (Colomycin Neb & Cipro Orally) - but he has been taken off the Amikacin due to the toxicity of using both together. He is relatively well apart from a cough. Does anyone have any comments on the implications of him growing all these bugs together ?? I want to know what to expect and am quite worried. We are lucky to have a fantastic team at our CF Clinic.
Answer
Thanks for this question about your son. Infection with mycobacterium
abscessus is an increasing problem and often very difficult to treat.

""There are guidelines from the American Thoracic Society
which speak specifically to mycobacterium abscessus infection and
approaches to treatment and although these speak about the use of amikacin they only mention amikacin delivered intravenously and not via nebuliser. That said at our adult CF Centre we frequently treat myobacterium with Amikacin nebs and Clarithromycin. I also am aware that there are some studies planned in this area"".


In summary, if eradication is not possible, treatment of flare-ups
(exacerbations) is probably the best way to provide treatment.
The Scedosporium is a fungal infection, similar in some ways to candida
and aspergillus. Again this is an organism which we are increasingly
identifying in the sputum of people with CF, particularly those who have
had long-term antibacterial antibiotics.
""The treatment for Pseudomonas is very appropriate with Colomycin
nebuliser and Ciprofloxacin. It is difficult to use Amikacin with
Colomycin and as Amikacin does have activity against Pseudomonas it might be better to use than the Colomycin. So at our centre we tend to discontinue colomycin when on nebulised amikacin. However it should be noted that Amikacin is very difficult to take compared to Colomycin"".

With regard to multiple bugs, this is an issue that is increasingly
apparent in CF. There were 2 whole sessions focusing on this at the
recent North American CF Meeting in Orlando. It is clear that most
people with CF have multiple organisms at any time and it is challenging
to know which is the most dominant and disease causing at any particular
time. With regard to knowing what to expect, Pseudomonas aeruginosa is
best eradicated as is mycobacterium abscesses, though for both these
organisms it can be difficult to achieve a complete cure.
Overall you are facing quite common challenges with your son with CF and
I am sure that with the collaboration of your team they will be able to
find helpful antibiotics to keep your son well.
Best wishes
Stuart
21.11.2008
The answer is edited by: Prof Stuart Elborn