Antibiotics how early?

Question

Unfortunately, our CF outpatient clinic and our paediatrician do not always share the same opinion.

The paediatrician suggests not giving antibiotics too early because otherwise one has to reckon with resistances in the following years. Apparently he performs controls at close intervals and then administers antibiotics if it is indeed necessary. The other day, we had a staph aureus in the throat swab with a mild bronchitis which he did not treat with antibiotics directly but only when it did not improve.

Our outpatient clinic recommends rather being more aggressive with antibiotics, since experience has shown that resistances are not the biggest problem initially but, if at all, only become one at a later age and that life expectancy and quality of life increase with a speedy antibiosis. Also, the immune system will not get weaker from prompt treatment with antibiotics – I thought it might get lazy from always giving antibiotics directly, when the body does not have to do much.

Sorry, this was not so short.
Thanks.

Answer

Hello,

there are differing opinions and therapy regimes concerning antibiotics therapy in CF. There are some CF centers that base their treatments only on the result of the throat swab or the sputum test, irrespective of the general condition of the patient. For instance, staph aureus or haemophilus influenzae are treated automatically upon evidence for about 2-3 weeks.

Other centers look more at the clinical signs together with the sputum or throat swab results. These centers would not treat automatically, for instance, if there are no signs of cough or other signs of an infection and only evidence of the respective germs.

Generally speaking, an antibiotics therapy is necessary if there is increased coughing that lasts more than three days or when there are signs of an upper respiratory infection (sore throat, cold, and fever) that last for more than three days. This applies even more so when a germ such as staph aureus was found.

Close monitoring is certainly helpful when treating a CF patient. The guidelines mentioned above, however, should be followed irrespective of that; otherwise one easily treats too late.

Frequent antibiotics therapies do not weaken a patient and her/his immune system. Repeated infections that are treated too late constitute a much bigger risk of this. The risk of developing resistances should be watched in CF patients. It can be avoided by a frequent change between different groups of antibiotics. Generally, one should apply an aggressive antibiotics therapy with CF. It is far more dangerous to treat too late once than two times too many.

Kind regards,
H.-G. Posselt.

29.10.2009