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Pseudomonas aeruginosa with excessive mucus formation

Dear expert team,

due to an infection with a strongly mucus-forming pseudomonas, the last two times I was in hospital for 5 weeks for an i.v. therapy with two antibiotics (Fortam®/ceftazidime & Amikin®/amikacin; colistin & Ciproxin®/ciprofloxacin). Both times, after 10 days, a resistance and fever developed, and I had to start over again with a different antibiotic for 14 days. After the 5 weeks, however, I still had a lot of secretion and cough, and it only got better after about 3 months of inhalation therapy alternating between Cayston®/aztreonam and colistin. I also have allergic asthma and am taking 10mg prednisone. My FEV1 was still at 52% a year ago and is now at 35%. I am 52 years old and have only needed five i.v. therapies so far. Is a prophylactic i.v. antibiotic therapy advisable under these circumstances, or would I then have to reckon with fever and a longer-term hospitalization again? How could that be avoided? I read that there are antibiotics that inhibit communication with each other; which ones would that be?

Many thanks for your help.

unfortunately, I will have to disappoint you right at the beginning of my answer, since your question would require medical advice for an answer, which is not possible via the internet. This expert platform can only inform, but we cannot give any recommenations for therapy. A doctor has to know the patient and his/her clinical findings well in order to be able to give recommendations like it would be necessary in your case.

However, let me give you some information which might make the conversation with your CF doctor easier.

With chronic pseudomonas aeruginosa (PA) colonization, particularly if it is a mucus-forming germ, long-term PA-effective antibiotics therapy is beneficial. Tolerability provided, these patients are mainly treated with inhalative antibiotics, and this usually as an on/off therapy with 28-day alternation. This is the kind of therapy you are receiving as well. One could think about whether a different antibiotics combination could be more beneficial (?).

Additionally, depending on the course of the disease, the inflammation signs, and the individual antibiotics tolerability and effect, i.v. therapy with PA-effective antibiotics can be carried out at regular intervals of 3-12 months. I.v. antibiotics therapy is usually carried out as a combination therapy (usually two antibiotics) for 14-21 days either at an outpatient clinic or at the hospital. The antibiotics are combined in a way that their effect is mutually increased but no negative interaction occurs. Which other antibiotics that could be used in your case depends on the antibiogram (germ sensitivity) as well as on your tolerability of and response to them. Therefore, do talk to you CF doctor about the therapy options that would best suit you.

I hope I could help you a bit with this information.

Kind regards,
Dr. Christina Smaczny