Exacerbation after infection

Question

I am a 40-year-old patient with CF and have 3 children. Actually I got a beginning cold last week with strong throat ache and rhinitis, after about 2 days a got a big spot (?) at the chin, which was very painful. My treating physician was unfortunately on holiday. I was right away beginning to take in ciprofloxacin 500 2x1 and doxycyclin 1x1 tablet, additionally I have a permanent antibiotic therapy with azithromycin 500 3 times a week. After two days of ciprofloxacin complete worsening, impression of dyspnea (strong obstruction), what should I do then, the physicians in my hometown are not familiar with CF, therefore I took a new antibiotic drug, namely cotrimoxazole 800mg 2 x 1 tablet and doxycyclin; furthermore I inhale with colistin and took prednisolon after a scheme, beginning with 50mg, at the end of about one week reduced gradually. This scheme I got from my physician last year in a similar case. In the meantime I have a bit less dyspnea, however it is still not really good, as in my family there are many infections....I will begin today with the inhalation of aztreonam, lets see what this will do. Otherwise I would like to ask which kind of therapies you would propose; do you also know such cuts? I have the impression that if one gets the menstruation, this has also an influence on the immune system, I have realized that I am more susceptible for infections then. Furhtermore I noticed, that in that time haemoptysis occurs more often, did you also hear about such experiences of your patients?
Otherwise I can say about my person that I am retired however I am taking care of a household with 5 people (husband 41, children 17, 11, 2 and me), I am doing the washing, clean, prepare the meals, take care of, play and am just a normal housewife.
What else can I do in case of dyspnea and obstruction, as I am also taking spray with ipratropium bromide and fenoterol. Inhalation with NaCl 0,9% and 8 drops of salbutamol 3 times a day.
Best regards and many thanks.

Answer

Dear questioner,
we ask for your understanding, that we cannot give individual medical advice via the internet, but can only inform you. I will try to give you information, that could probably be a help for you, however will not represent a concrete recommendation.
What I can conclude from your remarks is that you are an "experienced" CF patient and your approach with antibiotics could indeed be correct, however without knowing you and your results in detail, a medical judgment and recommendation is not possible. At last in case of the necessitiy to change an antibiotic, or in case of the question about the necessity of a systemic treatment with cortison, a physician should be consulted!
When answering your question many aspects have to be taken into accout, here just a few examples:
- Do you have a colonization with Pseudomonas aeruginosa?
- Which germ is responsible for the worsening in the foreground?
- Is it an infection anyway or just another cause that is responsible for the worsening?
- Is the dosage of the antibiotics right? (in general, ciprofloxacin is given 2 x 750mg in adult CF patients, not 2 x 500mg)
- Which experiences exist in the past with tolerance of antibiotics / non-tolerance?
- How great is the necessity to do an intravenous antibiotic therapy?
- Which experiences exist with inhalative antibiotics?
- How is the course of the inflammatory parameters?
- Which other problems do the illness of CF show?
- and, and....

As you see, without a direct patient-physician interaction a good therpeutical judgment is not possible. Therefore again the recommendation, plase turn directly to the physician of trust, probably also to another physician, who can of course get in contact with an experienced CF physician if he needs help in finding a decision.

In the second part of your request to the expert team you ask, if it could come to a general worsening during the time of menstruation in case of female CF patients and if then also lung bleeding occurs more often.
During menstruation it comes to a change in hormones which can indeed influence the immune system negatively. Many CF patients also report about an increased dyspnea during menstruation. This has to be treated individually and symptomatically (e.g. intermittend intensification of the anti-obstrucitve therapy, but also relax a bit in those days). To my knowledge a more frequent bleeding of the lung has no correlation to menstruation. In spite of this CF patients report, who already have problems with lung bleeding, that it occurs more often during menstruation. If at all and if yes, which conncetions and causes are underlying remains however unclear.
I hope to have helped you a bit with my remarks and stay with my best regards,

Yours Dr. med. Christina Smaczny

07.07.2015