Long term antibiotic treatment Cefuroxim

Question

Dear experts,

I am an adult cystic fibrosis patient (> 45 years old).
Currently I am taking Zithromax® (Azithromycin) 250mg as a long term antibiotic treatment every two days. Furthermore, I inhale Pulmozyme® and Colistin®.
I have problems with sinusitis. Polyps are excluded.
The last testings of the sputum and nasal secretion showed a resistance to Zithromax® every time.
This often leads to an acute infection, and then another antibiotic has to be used, according to test results.
My consulting ENT specialist wanted to try a long term antibiotic therapy with Cefuroxim, because it is sensitive till now. But the cystic fibrosis clinic said that this is not common. There are just experiences with Azithromycin, but I read in a forum about a case where a a long term antibiotic therapy with Cefuroxim was made. For one year [as it reads in the forum] the patient has had hardly any infections and no problems with the paranasal sinuses. She found it totally awesome.
My question: Could Cefuroxim be used for a long term antibiotic treatment with a lower dose?

Regards,
S.

Answer

Hello,

This unusual low dose of Zithromax® is a special case, which cannot be transferred to to other antibiotics.
The reason is a specialty of Azithromycin (Zithromax®): In the lower dose it disturbs only the counting mechanism of particular bacteria themselves (so-called Quorum-sensing); so that the bacteria think that their density (number in an area or volume) is as big as there is not any place left for their further growth (reproduction).
This is a protective mechanism which can be used to prevent further bacterial reproduction. This can only be done with Azithromycin and is originally not an antibiotic therapy.
A classical antibiotic therapy aims to kill the bacteria (bactericidal activity).
In full dose Zithromax® does the same, but this is simply another thing than the trick of “Quorum sensing” in a low dose.

So: No, you cannot transfer the concept to other antibiotics. This would just lead to cultivation of more resistances.
But there are some clues, that also with a result of resistance to Azithromycin this trick can still work.

Kind regards,
Prof. Dr.TOF Wagner

13.09.2015