S. aureus colonization

Question

Hello,
in the last swabs of our son always S. aureus has been found. Symptoms of an infection are usually not present; for two weeks he is coughing without fever, without sputum and without that he is doing generally bad. He is not taking an antibiotic.
First question:
is it generally o.k. to desist from a general antibiotic therapy or prophylaxis, if there are no symptoms going along with a S. aureus colonization?

Second question:
If in case of a proven S. aureus colonization there is intermittend for a few weeks cough without sputum and without fever, is it then still o.k. to desist from an antibiotic drug?

Third question:
in case a waiver of an antibiotic drug is actually o.k., what would be reasons for an antibiotic therapy: fever? Bad general condition? Or in case of persistance of the cough over 2-3 weeks would one initiate an antibiotic therapy, even if otherwise no other symptoms are present?
Many thanks for your efforts,

Answer

Dear questioner,
Your question has been answered today by Dr. Heuer per mail. The answer follows:
"S.aureus colonization = in case a colonization with S. aureus can be detected repeatedly, it is a colonization, possibly already an infection. Clinically there are indeed increased bronchial reactions with cough. Viral infections are often triggering an infection. As we know, that already at an age of 3 years in 30% bronchiectasis have been developed in CF, at the age of 5 over 50% have bronchiectasis, one has to treat at least intermittendly with an oral antibiotic drug against Staphylococci, e.g. for 2 weeks with Cefuroxim-axetil, amoxicillin+clavulanic acid, TMP/SMZ, in case S. aureus can be detected repeatedly.
A yearly thorax x-ray and the search for inflammatory markers would be helpful.
Therefore first question: repeated microbiological detection of S. aureus is suspect of a beginning chronic infection (comparable to the Pseudmonas germ). Intermittend antibiotic treatment: yes.

Second question: no.

Third question: No waiver of an antibiotic drug (see above). The antibiotic therapy has to be preventive. "The lung is free" is no contraindication for an antibiotic therapy! Repeated microbiological detection of the germ and also cough is an indication for an antibiotic therapy (see above).
Somatogram-x-ray of the thorax- laboratory (CRP- inflammatory markers with blood count and IgG) and clinical capacity are very helpful." [end of the mail]
Yours sincerely,
Dr. H.-E. Heuer

17.02.2014