How long taking antibiotics?

Question

Hello,
first of all thank you very much for this expert forum. It is a great help!
If an antibiotic therapy with cefuroxim has been intiated in CF child that had initially a viral infection that has been superinfected by bacteria (Moraxella catarrhalis, H. influenza) and the symptoms (rhinitis, subfebrile temperatures, reduced general state) have disappeared after one week, and the status is good again, only a slight residual cough remained, can the antibiotic therapy be finished soon? Or is there a reason, to continue the therapy for 3 weeks? With every day, the selection advantage for resistances or problematic germs is growing, isn't it? Should one therefore not limit the antibiotic therapy to "end of symptoms + a few days" instead of giving just at the beginning an overall duration of 3 weeks, even if the infection was over after one week?
Many thanks again for your time!

Answer

Hello,
you ask, if the antibiotic therapy of your child can be finished e.g. after 10 days or if the therapy has consequently to be continued for 3 weeks, as your child seemed to have had a viral infection initially, then Moraxella catarrhalis and H. influenza could be found and a therapy with cefuroxim led to complete healing after 7 days.
You address a generally very intensively discussed topic. In general it can be said, that CF patients have a more sensible airway system due to the slowly progressive lung damage compared to healthy peolpe. In many young patients there is also for a longer time period a permanent colonization with e.g. H. influenzae, in spite of an antibiotic therapy. Therefore in most of the CF centers it is true, that a necessary anti-infective therapy has to be done more intensively in CF patients (that means also longer), than in non-CF patients, in order to prevent a relapse. Many CF centers therefore recommend therapy durations of 21 days. Of course there are also centers, that regard 14 days to be sufficient. Often, the therapists take also into accout their experience with the patient for a long time period and his individual lung situation.
As you for sure would like to go on to be cared for in your CF center, you should address this topic with your CF physicians and come to a consensus, that is accepted by all of you. The worry about an increased risk of developing resistances, is for sure justified. This risk is however also present, if a therapy is finished too early and due to a relapse, another therapy would be necessary.
Therefore please talk about your worries to your doctors in charge. There will be for sure a solution, that is acceptable for both sides.
Best regards,
Dr. H.-G. Posselt

06.02.2017