Pseudomonas

Question

My daughter (7 years old, CF), is fighting for one year her Pseudomonas infection. We have already done two i.v. therapies and she is still inhaling with Colistin. Under the therapy, the swab was about 4 months ago positive for P.a. Is there still hope after such a long-term colonization, that one will again get rid of it? Or can one now assume, that it is chronic??
Should one do another i.v. therapy if the next test will be positive again? The last one has been done about 4 months ago. Or should one inhale Colistin and wait?? She is inhaling dry powder. Is it proven, that humid inhalation is more effective?? I thank you.

Answer

Hello,
you ask about a colonization of the airways of your 7-year-old daughter for 2 years with Pseudomonas aerugionsa. You report, that two i.v. therapies have been done and that your daughter inhales at the moment with Colistin dry powder. 4 months ago, Pseudomonas had still been found under this therapy. You ask, if in this situation a chronic colonization has to be assumed. Furthermore you ask, if another i.v. therapy would make sense and if probably a humid inhalation with Colistin could be more effecive than a dry powder inhalation.
To the question on the chronic colonization it can be said, that the risk is very high, that a chronic colonizatin is underlying after such a long time with recurrent positive findings of Pseudomonas. In spite of this, another i.v. therapy should be done in parallel to the inhalative therapy, if possbile with another combination than the one used before of two Pseudomonas-effective drugs. Furthermore it has to be considered, if Colistin should be changed to Tobramycin or another inhalative antibiotic, possibly for the duration of 2 months.
In general it can be said about dry powder inhalation that it is as effective as a humid inhalation, assumed, that the dry powder inhalation is done correctly. As you know, it has to be paid painstackinly attention to a fully emptied drug capsule. If you have the impression, that the dry powder inhalatin is difficult for your daughter, she should rather switch to humid inhalation.
I wish you and your daughter much luck.
Best regards,
Dr. H.-G. Posselt

04.06.2016