Pseudomonas aeruginosa for the first time

Question

Dear expert team,
my son, 6-years-old, CF patient, very good general condition, lung function 124, has for the first stime PA. A small amount of germs!
I am very much concerned and have great worries concerning my child. As the swab result before was totally normal, it can be said, that the PA is in the lung for nearly 3 months.
Besides a very dry cough (in the beginning), he does not show any symptoms. Now, about 3 months later, the coughs sounds sometimes phlegmy.

The university hospital is planning the following therapy:
oral therapy with antibioitcs ciprofloxacin 250mg for the first time for 4 weeks (2 times daily). In addition an inhalative treatment with tobramycin for the first time for 4 weeks (2 times daily). In the end, the inhalative therapy is intended to be over a time frame of 12 months (!!). This long duration is worrying me a lot due to the side effects.

My questions would be:
- How do other CF centers treat a first infection with PA?
- How are the chances to eradicate the germ, concerning the low number of germs as well as concerning the quite long time, my son carries the PA?

Many thanks for efforts!

Answer

Hello,
in principle, the therapeutic regimen that is proposed by your CF center, is correct. Of course, one could discuss about details, but one is trying at first, to achieve an eradication of the Pseudomonas. In our center, we prefer the treatment with two antibiotics intravenously (mostly ceftazidim and tobramycin) and regard the variant with ciprofloxacin orally and tobramycin or colistin inhalative as an alternative therapeutic option. We would also treat with ciprofloxacin longer as normally proposed (namely 3 weeks). With the inhalative antibiotics we would treat at least 3 months respectively as long as we do not find Pseudomonas anymore in 3 sputum/throat swab samples in a row.
In so far, the regimes differ only in detail. Concering the colonization with Pseudomonas in general, on can never determine the timepoint of the first colonization with 100% security. Swabs are the only specimes we can get from children, who do not experctorate sputum, for microbiological investiagtion (if one does not want to do a bronchoscopy). The Pseudomonas is however going to settle in the lung when the CF has changed the lung in so far that the surroundings for the germ are optimal. When this timepoint has come, can hardly be said from the outside and the child can be still of very good health then. According to our understanding, in additon to the antibiotic therapy, an intensification of the mucolytic and physiotherapy is important. I know a number of patients, who got for a start rid of their Pseudomonas with the therapy. The length and vehemence of the therapy reflects this aim. The experience over many years show, that the scale of an antibiotic therapy in CF patient is different from the scale in people without CF. The side effects are managable and should be accepted in this case. The side effect of an insufficient therapy is that the Pseudomonas stays and damages the lung in the long runs. Therefore I would recommend to accept the therapy proposal from you center.

Best regards,
Olaf Sommerburg

10.01.2015