IV effect

Question

Dear CF team,

I have been making the same recurring experience for several iv therapies:

Before the iv: a lot of sputum and low physical fitness.

One week after the start of the iv: less and lighter-colored sputum and better physical fitness –lasting for a few days.

Starting with day 11 of the iv: more sputum and worse physical fitness again – comparable to the condition before the iv – lasting until the end of the iv (day 14) and afterwards.

Further information: iv due to Pseudomonas and iv with Gernebcin® (tobramycin) (once a day 700mg) and Ceftazidime (3x2 grams) over two weeks. [Translator’s note: the original question had "Ceftafizim" – this was changed into "Ceftazidime."]

My doctor cannot explain the deterioration during iv.

What could be the possible causes for the positive effect under iv to vanish while the iv is still running, and how could these be clarified?

Answer

Dear questioner,

Your question is very clinical and can unfortunately not be answered over the internet. Without knowing you as a patient, your case history and your clinical findings, only generalized answers are possible, which, however, will not be of much use to you.

In your case, I would suggest that your doctor consults with another CF specialist about your case and then discusses the situation with you again. This is the way it is usually done in medicine. If there are any open questions that a doctor can not answer by her-/himself, a second specialist or a board is consulted.

Perhaps in your case the antibiotics dosage and/or the duration of the therapy could be changed/adjusted? Perhaps other antibiotics could be used? Perhaps an oral therapy (tablets) with an antibiotic effective against Pseudomonas aeruginosa or a different antibiotic should be done right after the iv therapy? Perhaps you require an additional antibiotic effective against Staphylococcus during the iv therapy against Pseudomonas aeruginosa? Perhaps physiotherapy should be intensified at different points during therapy? Perhaps the basic therapy should be changed? Etc. etc. etc.

As you can see, there are many open questions remaining; the above is only an exemplary selection. You can only find out together with your doctor which of them are applicable to your individual case and what can be done.

Kind regards,
Dr. Christina Smaczny

11.12.2012