staphylococcus aureus

Question

My daughter is colonized by Staphylococcus aureus and Pseudomonas aeruginosa. She finished an intravenous antibiotics course one month ago and she has already bronchial obstruction and dyspnea. If we manage to eliminate staphylococcus, will P. aeruginosa be less aggressive? Which antibiotics will you advise? Moreover, as she is infected, she suffers from joint pain and she is very tired.
Thanks for your help.

Answer

Dear questioner

It is difficult to answer your questions without any precisions as bacteria antibiotics sensitivity and organism count from sputum culture. The best thing is to speak directly with your daughter’s doctor.

Generally speaking it is not because you will eradicate staphylococcus that pseudomonas will be less virulent, and it is not always possible to eradicate staphylococcus. You have to treat the two bacteria giving priority to the organism which have the higher concentration.

To maintain pressure on Pseudomonas and trying to extend intravenous antibiotics efficacy, it is interesting to realize antibiotics aerosolize as colimicin or tobramycin between intravenous perfusion.

To treat staphylococcus, repeated courses of antibiotics with minocyclin (tetracyclin-group), cotrimoxazole- sulfomethoxazole, or pristinamycin may be efficient. Idea is to do in turns antibiotics to avoid resistance and to stop them for periods if it is possible. One example is to give antibiotic 1 for 15 days, then nothing for 15 days, then antibiotic 2 for 15 days… Of course, this example must be adapted to your daughter’s results and the duration she could feel well without antibiotics. Linezolid could be recommended from time to time. It is a very active antistaphylococcal treatment which is given in case of severe infection or as an alternative option when other antibiotics against staphylococcus are inefficient. It is not possible to give linezolid more than 14 days in a row because of cumulative toxicity. It is also possible to prescribe aerosol of gentamicin, an antibiotic active against staphylococcus in the same way aerosol are prescribed against Pseudomonas aeruginosa.

Another anti-inflammatory treatment as azithromycin could be efficient for patients who are colonized by pseudomonas or staphylococcus. Studies demonstrated a reduction of antibiotics needs, a little improvement of respiratory function and a better quality of life for patients who take azythromycin for a long time.


Sincerely yours

Dr Isabelle Danner-Boucher

23.05.2011