Pseudomonas

Question

Dear expert team,
my daughter has had a positive finding of Pseudmonas at the age of 14 months for the first time, which turned to be negative after 2 weeks of iv-therapy. 4 years later, at the age of 5 and a half years, Pseudmonas has again been in the swab and had been treated with 4 weeks Ciprofloxacin orally as well as 2 times a day inhalation of colistin. The first control swabs with and without antibiotic treatment were negative, 5 weeks ago unfortunately the result was positive again. Now she is told to take Ciprofloxacin and Colistin for 3 months. Unfortunately the last swab was positive in spite of the antibiotic treatment and I want to know, if one should change the therapy now and which alternatives there are for the current therapy?

Answer

Dear questioner,
The situation that you describe, eradication of Pseudomonas not immediately successfull, occurs in about 20% of cases. The by you described regimen is the therapy concept of the copenhagen CF-clinic. The results with that regimen are in the same range as with other eradication therapies. You can see from that, that also other eradication therapy regimes do exist. Another approach is the inhalation of Tobramycin. The results are in the same range as with the regimen your daughter gets at the moment. A change of the therapy in case of "failure" of the eradication therapy is not standardized and should be discussed with the local doctors in charge.
In case of additional signs of infection with Pseudmonas (in additon to the colonization of the mucosa of the airways, which can be detected in the sputum), a short-term intensification (e.g. iv-therapy) can be considered.
Best regards,
M. Ballmann

17.01.2010