Antibiotic treatment while on chemotherapy

Question

Good morning, we are taking care of an adult patient who is colonised by Pseudomonas and currently receives chemotherapy because of testicular cancer. Is an antibiotic treatment during every cycle of chemotherapy reasonable? I think this might be indicated because of the successive aplasia.

Answer

Hello,

Pseudomonas colonisation in my opinion is not a standard indication for an intravenous antibiotic therapy in connection with chemotherapy. However, it must be said that we have few to none data about this situation.
A consequent antibiotic therapy by inhalation of Tobramycin or Colistine during this time is to be recommended, and of course to initiate very quickly an intravenous antibiotic therapy at the first signs of an infection.

We actually know from the studies which investigated immunosuppression and the course of the lung disease in CF that immunosuppression with respect to inflammation caused by bacterial colonisation actually is even useful for the lung function, and research is still being done to find a drug which stops inflammation in the lungs without side effects.

Hence immunosuppression by chemotherapy rather may have no negative effect, and it will probably be enough to keep germs under control by consequent and highly dosed inhalation (that is twice/day) of the available antibiotics (if necessary according to antibiogram). It is important for your CF clinican to monitor your condition in close collaboration with your oncologist


With kind regards,
Prof. Dr. Joachim Bargon

22.01.2009