Always pseudomonas after visiting swimming pool – does colistin help prophylactically?

Question

Hello,

Our daughter (12 years, CF) was three times in an open air pool in her life and each time she had pseudomonas afterwards. It was always possible to eradicate it and she never had pseudomonas again.
As a matter of course she would like to go to the swimming pool but until now we have always forbidden it. Lately, we were told that one does not get pseudomonas if colistin is inhaled after being at the pool. Has anybody tried this before?

Answer

Hello,

You report that your 12-year-old daughter was infected with the pseudomonas germ in the past years after being at an open air pool and that the germ could be eradicated in each case successfully afterwards. You received the recommendation to have your daughter inhale colistin prophylactically before [in the question it says: after] visiting the open air pool. You ask if there exist experiences with such a prophylactical measure.
According to my knowledge there are no valid scientific studies about this.
Generally speaking there are causes of infection for CF patients in an open air pool. These are showers, sinks and toilets. If the water of the open air pool is well chlorinated, pseudomonas bacteria should not survive. Lakes are, however, a natural reservoir of standing water and can be an origin of water bugs like pseudomonas aeruginosa so that the risk is higher to be colonized with pseudomonas when swimming in a lake. Thus, CF patients should not visit swimming lakes.
If the infections happened in a regular swimming pool with well chlorinated water the attention should especially be drawn on observing the commonly known hygienic measures when going to the toilet or using the showers.
As a short-term inhalation with colistin does not bear any risks, I would encourage you to have your daughter inhale colistin 24 hourse before and for 48 hours after visiting a swimming pool. You should, however, also discuss this beforehand with your CF doctor. We wish your daughter much fun in the pool and a successful treatment with colistin.

Best regards,
Dr. H.-G. Posselt

31.07.2013