Antibiotics

Question

The newspapers are full of warnings against the adverse effects of antibiotic treatment. My pediatrician tells me that frequent or long term antibiotic treatment is not good. The doctor in the CF center however, prescribes antibiotics whenever my child coughs. I do not know anymore what's the best for my child.

Answer

Dear parent,
The lung disease in cystic fibrosis (CF) is characterized by chronic bacterial infection starting from a very young age. These infections leed to cough and secretions and slowly damage the lung of these patients. It is not fully understood why specific bacteria like Staphylococcus and Pseudomonas mainly infect the CF lung. Especially infection with the latter is known for its harmfull effect on the lung.
The life expectancy and quality of life for CF patients have dramatically increased over the last 10-20 years. Apart from improved treatment for digestive problems, the aggressive treatment of lung infection has mainly improved prognosis.
While a further healthy child overcomes most airway infections without antibiotics, in a CF child almost all airway infections are bacterial. Often these children are not very ill but have a persisting cough with secretions. If left untreated, these seemingly 'mild' infections damage the lung. In pratice, this means that frequent and often long standing antibiotic treatments are the cornerstone in CF treatment. These antibiotics can be administered by mouth, intravenously or by nebulization (depending of the type and severity of the infection). At least 2 recent studies (comparing CF center practices) demonstrate that CF patients do better in the long run if more frequently treated with IV antibiotics.
The drawback of this way of treating is indeed the possible development of antibiotic resistance. Correct use of antibiotics can somehow decrease this risk (start antibiotics guided by sputum culture, certain antibiotic combinations, alternate antibiotics etc). The development of AB resistance does however not mean the infection becomes untreatable. Therefore the risk of AB resistance does not outweigh the positive effects of strict AB treatment on the longterm disease course.

I hope this answer takes away your worries.

Kind regards

Dr M Proesmans

10.06.2008