Bronchiectasia and pseudomonas aeruginosa

Question

Hello,

I am a 22 years old girl and was diagnosed with CF two years ago. I have a mild form of the disease since pancreas function is more or less okay. The results of the other examinations are also very well. The problem is that I have bronchiectasia and pseudomonas aeruginosa (psa) in the mucus.
Before I start explaining the problem I have to say that in Bulgaria there are no CF specialists or CF centers. Most of the doctors have only heard about the disease and have treated only few patients.
Two weeks ago I coughed blood once. Then I went to the doctor and the treatment was ciprofloxacin (orally) and amikacin (intra-muscular shot) at home. After three days I started coughing stronger and went to the hospital. The treatment was Fortum® (ceftazidim) and Amikinitraven i.v. for nine days. After that, I have not coughed blood any more. Since four days I am at home and according to the doctor’s recommendation I take levofloxacin. The mucus is still green and thick. Therefore I told my doctor that I have to change from levofloxacin to ciprofloxacin. However, I know that it can cause resistances if the antibiotic is changed frequently. What do you recommend?!
And another question: Is bleeding of bronchiectasia dangerous of is it just a symptom of the infection?!
Greetings,

Answer

Hello,

Bronchiectasia and detected Pseudomonas aeruginosa is a frequent phenomenon in adult CF patients. In case of bronchiectasia, haemoptysis (coughing up blood) can happen several times and is in most cases the expression of an acute inflammation that is caused by bacteria, as e.g. by the Pseudomonas aeruginosa germ. A large number of CF individuals develop haemoptysis which is usually harmless and regresses under antibiotics therapy. Unfortunately, repeated bleedings occur frequently which then have to be treated repeatedly. Only in singular cases, massive heamoptysis can occur which is a life-threatening condition for the person concerned.

Antibiotics are a good way to treat infections and thus bleedings. In case of chronic detection of Pseudomonas aeruginosa, long-term therapies with inhalative antibiotics are recommended in any case.These are, e.g.: Bramitob® (tobramycin), Tobi® (tobramycin), Colistin® (colistinmethat), Colifin® (colistinmethat), promyxin, Cayston® (aztreonamlysin). Depending on the product, the inhalative antibiotics therapy is done “on/off” (alternately four weeks of inhalation and four weeks break) or permanently, mostly 2 – 3 times a day.

Antibiotics in oral form (tablets) or i.v. are mostly used in case of acute infection. In Germany, antibiotics are commonly not administered i.m. (no intra-muscular shots); an intravenous (i.v.) form of therapy is preferred.

For chosing the antibiotic for the i.v. therapy effective against Pseudomonas aeruginosa (which usually takes 14-21 days), the antibiogram (germ sensitivity test) of the sputum is considered. In order to avoid resistances of germs to antibiotics, two antibiotics are given at the same time (as was in your case). Among these are mostly a so called aminoglycoside (e.g. like amikacin or tobramycin) and a second antibiotic according to the antibiogram. Sometimes, after the i.v. antibiotics therapy the treatment is continued with an oral antibiotic treatment (tablets). In case of detected PsA ciprofloxacin is preferred to levofoxacin. Using antibiotics in CF patients is one of the most important and successful therapie measures that has improved the course of the disease and the life expectancy at large. However, the use of antibiotics has to happen in a conscient and sensible way in order to avoid resistances.

Best regards,
Dr. Christina Smaczny

29.03.2011