First infection with Pseudomonas aeruginosa

Question

Hello,
my daughter, 6-years old, is doing quite well, and has a permanent antibiotic therapy for 4 years with cefuroxim, now Pseudomonas has been found for the first time in the throat swab. We have then inhaled with Tobi for 4 weeks, unfortunately it has again been found at the control two weeks after cessation of the inhalation, now even in moderate number, before the number was rather small. Now we are starting again with Tobi and an oral therapy with ciprofloxacin. Should one give the oral therapy a chance or better do an i.v. therapy with tobramycin??? Is that more secure than an oral therapy? I just want that it disappears fast again. Would like to do a home i.v. therapy.
Best regards,
V.M.

Answer

[The question was originally asked on the German platform]

Hello,
according to the Guidelines, that are worked out at the moment, I do the following procedure in my center:

- Search for serologic PSA-antibodies - how high are the inflammatory parameters (CRP)?
- X-ray of the thorax in one layer
- 3 weeks of ciprofloxacin 20mg/kg body weight per day in 2 dosages (e.g. Ciprobay® 10% fluid)
- Tobramycin 2x300mg per inhalation for 4 weeks
- 1 week after ciprofloxacin and tobramycin another thraot swab - if then again finding of PSA-->
- 2 weeks of tobramycin 10mg/kg body weight once per day i.v. plus ceftazidim 3 times a day i.v. (150mg/kg body weight and day in 3 dosages) home i.v.
- After this, 2 times a day Colistin 1 Mio units over 4 weeks and then again a throat swab and discuss it with the CF center
- in any case one should give the oral therapy a chance, i.v. antibiotic therapy is more invasive and more effecitve!

The treating physician of your daughter knows the situation the best, therefore it is necessary to discuss the procedure with him.

Best regards,
Dr. H.-E. Heuer

28.06.2015