Staphylococcus aureus and Haemophilus influenzae

Question

Dear experts,
the sputum of my 8-year old daughter (CF) was positive for Staphylococcus aureus again and again in the course of the last year and sometimes positive for Haemophilus influenzae. This was treated orally with cefaclor, finally with a 14-day i.v.-therapy (cefotiam). The cough disappeared totally. After being back at school for some days, at first a rhinitis developped followed soon by a spasmodic cough. Masses of Staphylococcus and plenty of Haemophilus influenzae have again been found in the sputum. Now she takes again cefaclor orally. Which future therapeutic strategies such as a switch of the antibiotic drug or permanent antibiotic therapy do we have to take into account?
Thanks in advance and best regards,

Answer

Dear parents,
a colonization with Staphylococcus aureus and Haemophilus influenzae is quite common at that age, even in non-CF patients. Many of our young CF-patients, who are Pseudomonas negative, are colonized with Staphylococcus or Haemophilus.
The causes of cough are various and are not necessarily connected to the bacterial colonization. Most frequently we have to deal with viral infections (typically the rhinitis comes first), but also pertussis, mycoplasma etc. can lead to a longlasting, spasmodic cough.
By giving an anti-staphylococcal antibiotic therapy the possible superinfection with bacteria is treated, however not the underlying infection; the latter is healing in the course of time. A treatment with antibiotics is advisable in any case when there are symptoms such as longlasting cough, fever, exhaustion, loss of apetite, etc. After finishing the antibiotic therapy, another colonization with these germs will happen.
At the moment, a permanent oral therapy with an anti-stapyhlocccal antibiotic is not recommended, as there are hints, that those bacteria protect against the appearance of Pseudomonas.
There are different possibilities to deal with colonization/infection with Staphylococcus aureus: in Copenhagen (Denmark) monthly swab cultures are done and an antibiotic therapy is recommended each time Staphylococcus can be cultured. As one can assume that one has to deal each time with another type of Staphylococcus, no resistances develop. In Great Britain a permanent oral therapy against Staphylococcus is recommended in the 2 first years of life, after that time period however, it is not recommended anymore.
In our CF-centre we recommend an antibiotic interval therapy adjusted to the symptoms, i.e. we do not treat necessarily every colonization but only if symptoms of the illness or a worsening of the lung function occur. In case the children are ill again and again during the months of the winter, we do recommend an antibiotic therapy during the infection-time of the wintermonths, but we stop this therapy in springtime. As we are investigating swab cultures every 4 weeks, we have a detailed overview about the microbiological situation of our patients. A permant therapy against Staphylococcus is usually not advised, because there are some hints that such a therapy could support the appearance of Pseudomonas. In case of the symptom-orientated antibiotic therapy, the administration of e.g. cephalosporines and flucloxacillin can be done alternately. A preceding swab culture is always advisable. Now the hard time of infection is over soon and you can await a summer without infections and without antbiotics.
I wish you all the best and with best regards,
Dr. Silke van Koningsbruggen

08.07.2008