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Permanent antbiotic treatment

Question
Dear ladies and gentlemen,
our child has been told to undergo a permanent antibiotic treatment with a cephalosporin. I am afraid of the side effects, especially because I have noticed that our daughter gets very nervous and hyperactive when getting antibiotics.
Is that a general effect or are there different effects of the antibiotics on the "nervous system"? In the Roche-Focus has just been written that the CF Foundation recommends Azithromycin for a permanent antbiotic therapy?
Thanks for your information.
Answer
Hello,

The question of the side effects of a permanent antibiotic therapy has
always to be regarded in connection with the indication. Only by this,
advantages and probable disadvantages can be weighing up in a sensible way.A permanent antibiotic treatment can be initiated to prevent the patient of acquiring a certain germ, this is called a prophylactic treatment and can be discussed in special sitatuions for certain germs (for example Staph. Aureus). Or a permanent treatment is initiated with the aim of treating a preexisting germ and certain circumstances do not allow to end the therapy (e.g. the germ can not be eradicated by the therapy but can be kept at bay, e.g. permanent inhalative antibiotic therapy in case of chronic Pseudomonas colonization).

Many antibiotic drugs have an influence on the central nervous system,
mostly when given in high dosages in an animal model. However, the specific
substances differ in their extent and effect on the central nervous system,
including increased nervousness and, in very rare occasions, even an
increased epileptic activity.

In the case of your daughter one will also have to do such a risk-benefit
consideration.

Frequent antibiotic treatment is often necessary when suffering from Cystic
Fibrosis. Permanent treatment however, this has been shown for cephalosporines when used as prophylactic treatment against Staph. aureus for example, can lead to a higher rate of Pseudomonas aeruginosa acquisition compared to treatment only in case of a positive finding of Staph. Aureus. As we do not know the reason why your daughter receives a permanent cephalosporine therapy (is it a treatment or a prophylaxis and at which age is she receiving this therapy) it is impossible to comment on this and it should be discussed with the physicians in charge of your CF center.

The recommendation of the CF Foundation for the therapy with Azithromycin in
CF is also an expression of such a risk-benefit consideration. The single
case can of course be different form the group of patients. This
recommendation, however, is only for patients over 6 years of age with a
chronic colonization of Pseudomonas aeruginosa, which does not seem to be
the case in your daughter, so it is not a general recommendation for every
CF patient.

Yours sincerely,

Dr. M. Ballmann

24.11.2008