Staphylococcus aureus and Haemophilus influenza

Question

Dear expert team,
in the throat swab of our daughter (actually 1.5 years old, diagnosed with CF at the age of 3.5 months) the above mentioned germs have been found (Staph. already for the third time / Haemophilus for the second time, there were months, where she was free of germs).
Our actual CF physician does not want to start an antibiotic therapy in spite of the above mentioned result, as she is doing well. That means oxygen saturation 100%, auscultation of the lung good, weight and height o.k., apetite very well, stool o.k., no hearable and visible mucus congestion, no cough. Our physiotherapist does not feel any suspicious mucus.
We inhale always 2 times daily with NaCl plus 3 drops salbutamol and 5 puffs of ipratropium bromide.
Our former CF physician had prescribed quickly antibiotics for 3 weeks in case of the above mentioned germs.
My husband and I, we decided for a demand oriented antibiotic therapy. But is there demand then at the moment??? Due to the different kind of actions of the physicians we are insecure.
Should one give an antibiotic only then, if there are symptoms of infection, as e.g. mucus=hotbed, or better in general, means in case of finding of the germs?
In case we would not have made a control throat swab, it would not have been visible that our daughter is colonized with germs at the moment, as she does not show any suspicious symptoms.
Many thanks for your help.

Answer

Hello,
you ask, if an antibiotic therapy should be initiated in the case of your 1.5 year-old daughter, in whose throat swab Staph. aureus and Haemophilus influenzae could be detected repeatedly altough she does not show any signs of infection and there is no mucus congestion of the lungs detectable. You are insecure because your former CF physician always proposed a phrophylactic therapy in such a case for 3 weeks. You yourself and your husband decided for an infection-oriented therapy in such situations.
For the situation of your daughter no uniform guidelines exists. There are CF-physicians and resp. also CF-centers, which recommend an antibiotic therapy for 2-3 weeks in case of the finding of Staph. aureus or Haemophilus influenzae in general and indenpendent of sings of infection, as it is known, that both germs have the potential to damage the lungs. In case one takes a control swab about 3 weeks after the end of the antibiotic therapy, one does not find seldom those germs, which have been detected before. This would lead to a repeated short-term antibiotic therapy in case of a consequent following of this treatment regimen. As it is known, that some CF children show a state of permanent colonization with Staph. areus independent of any treatment, there are centers, which do perfome a so-called permanent prophylaxis against Staph. aureus. Such a long-term treatment did not show a named advantage of the long-term treated patients in a large study. On the other hand an increased number of patients earlier infected with Pseudomonas aeruginosa could be found among the permanent treated patients.
On the basis of all these experiences parents and treating physicians should find a consent treatment regimen. You and your husband decided for an infection-oriented antibiotic treatment. The acutal CF-physician seems to share this opinion. You can follow this approach therefore trustfully. It is important that you observe your daughter well and in case of any change of her general condition contact your CF physician. Perhaps you can find a consensus with your CF-center about more frequent routine controls - similar to the Copenhagen-model.
Yours sincerely,
Dr. H.-G. Posselt

21.03.2011