Paranasal sinuses

Question

Hello,
When a child with cystic fibrosis has a “blocked nose” for 2 weeks, and the secretion is just liquefied through inhalation with MucoClear®; should one then begin with an antibiotic treatment in order to prevent a bacterial infection of the paranasal sinuses? Is this also true if there isn’t any infection of the bronchi and the lungs?
I mean if there is just a persistent flue for 2 weeks, without any fever, cough, or any other symptoms. Or can we just wait, until (if) fever, cough or any other symptoms occur?
Thank you for your assessment.

Answer

Hello,

That is a really good question.
Basically, there is a consent that an infection of the lower respiratory tract in cystic fibrosis – as there is a regular colonization of the airways with problematic germs – has to be treated with antibiotics in order to prevent developing scarring of the lungs.
For the upper respiratory tracts, which have not really been studied microbiologically until few years ago, there is no consent about this yet.
And this, although the most respiratory infections of toddlers often begin in the upper respiratory tracts.
From here it leads to descending infections of the lower respiratory tracts (“postnasal drip”).

If this is the typical course of events of the affected child again and again, I would recommend a very generous indication for an extended antibiosic therapy for 20 days; similarly with the evidence of problematic germs in the nasal irrigation (which can be done in this age with e.g. Rhinoclear® or Rhinowash®) or in the deep nasal swab.
If there is a blocked nose again and again, a preventive therapy attempt with low dose cortisone nasal spray can make sense for some weeks (the dose has to be so low that no relevant amount of the substance can be detected in the blood - e.g. Avamys® or Nasonex®).

Decongestant nose drops or sprays can also be used in the beginning of such a therapy for about 5-7 days.
But if used for a longer time, the nasal mucosa is dried out and therefore a drug related rhinitis can occur.
If secretion is the predominant issue, regular nasal douches with a nasal jug or the other above-mentioned utilities make sense, if need be with higher concentrated or buffered saline solution.
As an easy method, that can be carried out quickly, we can recommend also a seawater nasal spray from the drugstore. But CF individuals should not use it for more than one week, because of the risk of germs.

Best regards,
PD Dr. Jochen Mainz

13.09.2015