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staphylococcus aureus

What are your recommendations for the treatment of Staphylococcus aureus?

In my country, staph is untreated If there are no significant symptoms.

My son was diagnosed with staph, but it is not treated becouse he is a good general health with just a little cough, no fever, ...

Thank in advance
Dear Questionner

Thank you for your question.
Staphylococcus aureus is a common pathogen in CF and is detected in the sputum of many children with CF. There are different approaches to treatment of asymptomatic Staphylococcus aureus infection which is what you have described your son has. Some centres include short term antibiotic courses in response to a positive sputum culture like your son has, and other centres use antibiotics therapy only if the sputum culture is associated with clinical symptoms.
Other CF centres use prophylactic treatment from diagnosis to reduce the prevalence of Staphylococcus aureus infection.
In terms of research it is not clear whether prophylactic treatment or intermittent treatment as described above improves clinical status in CF. In fact the UK the guidelines recommend “continuous, anti-staphylococcal antibiotic prophylaxis, with a narrow spectrum antibiotic such as flucloxacillin”. In patients who become infected with Staphylococcus aureus the dose of flucloxacillin, is increased and a second oral anti-staphylococcal antibiotic may be considered. This can be continued to eradication and if the patient feels unwell then a course of IV antibiotics may be considered. This is the treatment approach in the UK however we would emphasise that not all centres have the same approach. It is important that you discuss your sons management with your own CF doctors who are best placed to direct his therapy. If there is any change in your sons symptoms it is important that you contact your CF centre to discuss if any treatment is required.

Prof Judy Bradley
Prof Stuart Elborn


Antibiotic treatment for cystic fibrosis - Cystic Fibrosis Trust Report of the UK Cystic Fibrosis Trust Antibiotic Working Group 2009

The answer is edited by: Prof Judy Bradley

There are Euopean guidelines commenting on the treatment of the finding of S. aureus, as well as on the antibiotic prophylaxis in order to avoid the first colonization with S. aureus:

-Döring et al. in the Journal of Cystic Fibrosis 11 (2012) 461-479: “Treatment of lung infection in patients with cystic fibrosis: Current and future strategies”:
"S. aureus has long been found in the airways of CF patients and has been thought to be a predecessor of later infection by P. aeruginosa and appears to be associated with increased lower airway inflammation. As such, some have advocated for prophylactic therapy against S. aureus, a strategy that is being recommended in the UK and other countries but has not been adopted by clinical practice guidelines in the US. This is based upon data from a long-term placebo controlled trial in which there was no clinical benefit for those on prophylactic antibiotic therapy after 7 years of treatment."

- Döring et al. in the Journal of Cystic Fibrosis 3 (2004) 67-91: "Early intervention and prevention of lung disease in cystic fibrosis: a European consensus":
"Many patients with CF are initially infected with S. aureus. There is in general agreement to treat such patients with anti-staphyloccocal antibiotics for 2 to 4 weeks. This may eradicate the organism."

In Germany, as another example, accordingly, the rule is in general to treat any finding of S. aureus, even in asymptomatic patients.

It becomes clear that even if there is no uniform, binding recommendation, the general policy is to treat this germ, even if policies in CF centers may differ. Therefore, as mentioned in the answer, it is of great importance to discuss this issue directly with the CF center in charge.

D. d'Alquen