User login

Enter your username and password here in order to log in on the website:

Forgot your password?

Please note: While some information will still be current in a year, other information may already be out of date in three months time. If you are in any doubt, please feel free to ask.

Treatment of the sinuses

Dear expert team,
I have a question about the treatment of Pseudomonas in the sinuses.
Due to an intermittend Pseudomonas infection of the airways, my CF center suspected, that Pseudomonas could also be in the sinuses and should be also treated there, even if the finding of Pseudomonas in the nasal swab and nasal lavage was negative.
Now I inhale for the airways colistin and tobramycin one after the other for several months.
For the sinuses, colistin has however been prescribed for only 28 days via Pari-Sinus. My CF center is of the opinion, that this duration is sufficient for an eradication of Pseudomonas from the sinuses.
What is your opinion? Are there any reports about an eradication of Pseudomonas from the sinuses after only one month of colistin inhalation via Pari-Sinus? Or is a longer sinu-nasal therapy needed, e.g. as long as the duration of the therapy of the lower airways?
Many thanks for your answer and your efforts.
the possibility, that Pseudomonas aerugionsa could also persist in the nose and your sinuses has been underestimated for a long time period. Therefore it is very positive, that your CF center is thinking about this possiblity and acts accordingly. Especially when only bronchial inhalation with Pseudomonas active antibiotics is done, a problematic germ that is persisting in the upper airways, can again and again recolonize the lung after the end of the bronchial therapy. Recently it has also been shown, that the germ can persist in gingival sulci and on braces. In general, also little amounts of the germ can survive in the lungs and after therapy reoccur again and again or it can come to a recinfection from the environment, e.g. from not sufficiently dry inhalation equipment.
We do not have clear data, yet, how often the upper airways can be in this segment an area of persistence even without finding of the germ.
In general, we have eradicated Pseudomonas from the upper airways with a one month lasting additional inhalation of tobramycin, colistin and/or aztreonam. Some patients however, had to do several cycles.
For us it is standard in case of an intermittend colonization, to control monthly the germ colonization of both airway segments - always three days after cessation of the treatment, in order to find out if there is a persistence and probably intiate further therapies. This is then for us a combination of inhalative and systemic antibiotics (oral or i.v.) and in case of a nasal finding of the germ, a good training for using the Pari-Sinus is very important (there are also training films in the internet).
Furthermore we control in case of an intermittend colonization, if there is an increase of P.a. antibodies in the serum.
In summary we have learned, that a very consequent and also long-lasting therapy can lead to eradication in case of CF patients, where we had accepted in former times a persistence. Therefore I would like to encourage to check the above mentioned reasons for persistence regularly and go on consequently with therapy.
I keep my fingers crossed that the eradication would be successful.
Best regards,
PD Dr. Jochen Mainz