antibiotics

Question

Hello,
My daughter whose 18 month old child was diagnosed with CF at birth, has the impression that doctors routinely give antibiotics without sputum culture. Practitioners criticize each other, we even heard a "if you want". Knowing that having a sick child greatly fragilizes her, it's not up to her ... Could you inform and reassure her. She is concerned that unnecessary treatments today could limit the possibilities for later treatment. Thank you for your response.

Answer

Hello,
Newborn screening for cystic fibrosis has been generalized in France partly because of two factors: early management and the ability to implement care in specialized center (CRCM) with nutritional surveillance, respiratory and infectious and preventive and curative treatments adapted according to current recommendations.

These recommendations include monitoring at least 4 times a year the child in the CRCM with at each visit to a review of the past weeks, a clinical examination, microbiological sampling of bronchial secretions (or pharynx, if the child does not spit) and when the child is capable (from 5 years, sometimes only 6 years old) a complete measure of breath (lung volumes and flows) called pulmonary function tests.

Any persistent respiratory signs (coughing, respiratory difficulties, fatigue on exertion ...) or that can be linked to a respiratory infection (decreased appetite, weight loss or inadequate intake, ...) should prompt the discussion the of antibiotic treatment, whose choice will be guided by the culture of the secretions. Similarly, the presence of bacteria such as staphylococcus or pseudomonas aeruginosa in bronchial samples most often leads to the initiation of antibiotic treatment, even if the child has no clinical symptoms.
We can now say that early and repeated treatment with antibiotics played a major role in improving life expectancy of patients with cystic fibrosis. Provided that the doses and durations of antibiotics are met and appropriate (patients with cystic fibrosis often require higher doses due to metabolism and elimination increased), the risk of emergence of resistance is limited.

The role of parents, it should not replace the medical team, however, is fundamental in the management of chronic illness. Indeed, parents know their child better than anyone and can identify at first, the first and small warning signs suggestive of a respiratory exacerbation (less spirited, disturbed sleep, grumpy ...). Dialogue with the doctor allows parents to participate in treatment decisions and facilitate the application of prescribed treatment.

I encourage you to support your daughter, so she can play this role in partnering with the team caring for your little son.

I hope that answers your questions
Sincerely,
Dr. Sophie Ravilly

07.06.2011