Aerosol in an 18 months-old child

Question

A Pseudomonas aeruginosa has been found for the first time in the sputum of my 18 months-old son. The CF Centre physicians have decided to treat him with twice daily nebulized antibiotics (15 minutes per nebulization). He totally refuses the nebulization and when I force him to do that, of course he’s screaming and crying. So, I am in doubt with the treatment efficacy. Is there another possibility? On the other hand, because of this primocolonization, will my son require regular antibiotics treatments in the future? Is it possible to eradicate this bacterium? Thanks for your responses.

Answer

Hello,
To deliver an inhaled therapy to a young child is not so easy. In ideal conditions (quiet respiratory cycles, well fitted facemask) the maximal percentage of delivered drug into the lungs is about 5% with the available nebulizers. Tears, cries, screams dramatically decrease this percentage up to 0.5% and of course question about the treatment efficacy. A possibility to better tolerate the treatment is to inhale from a large hood where the child can quietly breathe without facemask on the face.
In case of primocolonization, various protocols of treatments are validated with different routes of delivery (nebulization, oral or intravenous route). All these regimens aim to eradicate the bacterium for a time as long as possible. The future antibiotic strategy will mainly depend on the obtained success or not. Don’t hesitate to discuss this problem with the physicians of your son.
I hope to have responded to your questions. Best regards,
Prof Jean-Christophe Dubus

21.01.2013