Carbapenems

Question

Hello,
in the past time, an i.v. therapy (four times in 6 months) has been done several times in order to fight the bacterium Achromobacter xylosoxidans. This has been always very successful with Imipenem/Cilastin and 3-4 weeks no further intake of antibiotics had been necessary. However, again and again dyspnea, irritative cough and increased Achromobacter reoccur. Basically, there is no problem, as the i.v. therapy is still well effective and FEV1 returns to the good starting point of about 65% (even if under irritative cough the value is around 50%). However in daily life and for timely reasons, it is not easy to do an i.v. therapy every 4 weeks. The overall health condition is good otherwise.
Is there any antibiotic drug from the group of Carbapenems that can be taken orally or via inhalation? Or could one inhale something? I remember, that Colistin for fighting the PA has also been recommended to be inhaled by the physician, long before the license for inhalation was given, even if on the package it could be read that it deals with the i.v. solution.
Many thanks

Answer

Dear questioner,
as you turn to the CF expert team, I assume, that you are suffering from CF and that the germ has been found in the sputum. I will try to answer your question in this context.
From your question one can conclude, that you obviously have already a chronic colonization with Achromobacter xylosoxidans, and that the germ causes recurrent acute infections. From the literature it is known, that the first infection as well as the chronic colonization can be accompanied by acute exacerbations of the pulmonary manifestation of the CF. Obviously this is also the case here. Fortunately, you respond always well to the therapy with antibiotics from the Carbapenem group (Imipenem-Cilastin). Carbapenems can however be administered only by the i.v. route. Actually, I am not aware of any study that is investigating Carbapenems in the inhalatinve form.
Which antibioitcs can be used for you alternatively, can not be answered via the Internet without knowing you and your results in more detail. Information about other finding of germs and details on the anitbiogram are essential for the choice of kind, administration route and duration of therapy. Possibly, the increased suceptibility for infections is also due to other germs (bacteria, viruses) or other health problems (e.g. impairment of the glucose metabolism, under weight), not known to us.
In case of a decision about an antibiotic therapy, always the whole situation of a patient has to be taken into account. The knowledge of a single finding, in your case that of the germ that has been found in the sputum, is not sufficient for a decision.
In this context, we recommend to turn to your CF pyhsician in charge, and to talk to him about your question. Our answer can serve you as a help at this talk and we are sure, that you will find an optimal therapeutic strategy together with your physician.

Yours sincerely,
Yours
Dr. med. Christina Smaczny

02.04.2015