Antibiotics after throat swab

Question

Hello,
I have posed lately a similar question. You have written to me that some centers treat according to the result of the swab and e.g. give antibiotics even if there are no signs of infection but a Staphylocuccus.
Our daughter (1 year) still had a Staphylococcus in the swab, is however healthy at the moment, is there an antibiotic treatment necessary, it has been even said that if it is not going to be better, it should be administered i.v.? Without symptoms? She is putting at the moment everything in the mouth, is then a colonization with Staph not "normal"?

Answer

Hello,
you report that you daughter shows repeatedly the finding of Staph. aureus in the throat swab and that she is thereby totally free of symptoms. The doctor in charge of the CF-center seemed to have recommended an antibiotic therapy to you. You ask, if such an oral therapy, and, if it will not eliminate the germ sucessfully, even an i.v. therapy would be necessary.
As you have already heard, there are differeing opinions under the CF-doctors concerning the necessity of a treatment of Staph. aureus. Some physicians treat in case of the finding of the germ, even if there are no clinical symptoms or laboratory findings, which speak for an inflammation (so-called elimination-therapy or prophylaxis).
Other physicians treat only with underlying signs of infection.
It is often not successful to eliminate Staph. aureus with an oral therapy in the long runs. An i.v.-therapy only because of the trial of elimination of the germ, does not appear sensible, as one has to expect a fast recolonization. In case narrow controls can be guaranteed by the CF-center, a so-called prophylactic therapy is not necessary.
I think that it is important that you can agree with your CF-doctors on a common procedure, that can be carried by all together in responsibility.
Yours sincerely,
Dr. H.-G. Posselt

02.11.2009