pseudomonas

Question

Hi

my daughter is 3 years and pseudomonas is found for the second time in 2 months. Our center offers the same treatment again ( 4weeks of tobi inhalations and ciprofloxacin) it didn´t remove the pseudomonas this time and i am affraid it will not take it this time. I am aware that other centers are more agressive and would use 14 days of IV treatment and then 3 months of tobi.

shall we accept the same treatment or ask for the agressive treatment?

what would you do i am so affraid of the pseudomonas turning chronic.

Landvad

Answer

Dear Landvad
Thank you for your question regarding eradication treatment regimes for Pseudomonas aeruginosa.
There are a variety of regimes that can be used for eradication.
• For children who are well at the time of first isolate of Pseudomonas many centres will treat with a 3 month course of oral Ciprofloxacin and nebulised Colistin. Eradication rates of between 80%-90% have been reported with this regime. After 4-6 weeks of treatment a repeat sample should be taken. If Pseudomonas is still cultured at that stage a two week course of intravenous (IV) antibiotics usually Ceftazidime/Meropenem & an aminoglycoside (Tobramycin)should be considered. One month (28days) to 2 months (56 days) of nebulised Tobramycin is also an appropriate initial eradication therapy. Some centres may also use Azithromycin orally three times a week during the treatment.
• If the child has a respiratory exacerbation at the time of 1st isolate of Pseudomonas then it is usually standard practice to start with a two week course of IV antibiotics. Then the patient should continue on nebulised Colistin and oral Ciprofloxacin for a total of three months. Alternatively nebulised Tobramycin can be used , depending on the centre’s practice. One month (28days) to 2 months (56 days) of nebulised Tobramycin is also an appropriate initial eradication therapy. At that stage if eradication is not achieved then the patient should continue on long-term nebulised anti-pseudomonal therapy either continuous Colistin or Tobramycin (28 days’ on/28 days off).
• Once eradication has been achieved there has to be a decision on how long therapy should be continued. This is still under debate and is dependent on different practice in different centres. Most centres will continue therapy until the patient is one to two years pseudomonas free.
To answer your question it is important to discuss your options with your CF team and the need for IV antibiotic therapy or alternative therapy if initial eradication regime has failed . I hope you find this information helpful in dealing with your daughter’s current problem.
Below are references of some of the materials used to help answer this question.

References
CF Trust Antibiotic Therapy Guidelines 2009
The Leeds Method of Management. April 2008. www.cysticfibrosismedicine.com
Eur Respir J 2000;16:749-767 Antibiotic therapy against Pseudomonas aeruginosa in cystic fibrosis: A European consensus. Döring et al.
J Cyst Fibros, 2008 Nov;7(6):523-30. Early aggressive eradication therapy for intermittent Pseudomonas aeruginosa airways colonisation in cystic fibrosis patients: 15 years experience. Hansen CR, Pressler T, Hoiby N.

21.06.2011

The answer is edited by: Laura Jenkins