Achromobacter and Colifin®

Question

I am 48 years old. In November 2013, Achromobacter has for the first time be found in my sputum and also Pseudomonas, the latter for the third time (always with large year-intervals inbetween).
My lung function value FEV1 was always in the range of 55-57%. Unfortunately, from February 2013 on, I had pertussis (whooping cough, detected by antibody titre). During the illness of pertussis, my lung function value decreased to 52%.
At the same time as the finding of the germ, a lung function test had been performed in November, FEV1 value was 45%. Eradication trial with Ciprobay® (ciprofloxacin) 2 times a day for 30 days and inhalation of Colifin® (colistin) 2 million units 2 times a day now for more than 4 months.
Result: Pseudmonas could not be detected after 30 days anymore, in all further sputum results it could not be detected either. Achromobacter still in the finding.
Question 1: Shall I go on with inhalation of Colifin®? When inhaling, I have a marked dyspnea until 30 minutes after inhalation, I am spastically narrowed and have strong episodes of cough. My lung function did not improve under the therapy and as a side effect i.a. a worsening of the lung function is indeed mentioned.
Furthermore I have increased blood in the sputum when coughing.

Question 2: Can this be due to Colifin® or rather from the colonization with Achromobacter?

Question 3: Shall I do an i.v. therapy, in case to get rid of Achromobacter in the end?
Many thanks for your efforts in answering my questions.

Answer

Dear questioner,
at the beginning of my answer I have to draw your attention to the fact, that the expert team can only inform, however cannot make a recommendation. Therefore, my answer can only be formulated according to this. However, the information that you get here, you can use for talking to your treating physician, so that the optimal therapeutic recommendation can be worked out for you personally.

At first, few information about Achromobacter xylosoxidans. In the "requirements on hygiene for the medical care of patients with CF" published by the KRINKO (German comssion for hospital hygiene and infection prevention) 2012 at the RKI (German Robert-Koch institute), Achromobacter (former Alcaligenes) xylosoxidans is often defined as a multiresistant and therefore difficult to treat nosocomially transmitted, oppurtunisitic pathogenic germ in CF patients. The first infection as well as the chronic colonization can be accompanied by acute exacerbations of the pulmonary manifestation of CF. While former studies could not show an unambiguous correlation between the infection with A. xylosoxidans and a chronic respiratory worsening, authors of a study (Hansen CR et al.) found in 2010 chronic increased inflammatory mediators and a steady decrease of the FEV1 value, that was comparable to a chronic colonization with Pseudomonas aeruginosa.

Now to your questions:
1st question:
With any drug, that is also true for inhalative Colifin® (colisitn), besides the effect, side effects have always to be taken into account. The side effect should in no case overweigh the "therapeutic value" (the effect). Therefore in your case a talk to your physician in charge is mandatory in order to weigh the pros and cons and to make the right decision for you.

2nd question:
Coughing up blood can be caused by inflammatory processes, also an infection caused by germs (also Achromobacter) can be the reason. It cannot be excluded that coughing up blood is caused as a side effect by an inhalative drug. Often the cause cannot be found precisely and one has to go on further pragmatically. Which cause is responsible for the hemoptysis in your case, can only be found out with your physician in charge, who knows you and all your results well.

3rd question:
In case of occurrence of signs of infection, increased inflammatory parameters, finding of germs and other signs of infection an i.v. therapy with antibiotics can be necessary. This question can however in the end not be answered by us via the internet. Also in this case you should talk to your CF physician in charge and get advice from him.

We hope to have helped you with our remarks and send you our best regards,
Yours
Dr. med. Christina Smaczny

30.04.2014