Eradication of Pseudomonas - new therapy

Question

Hello,
after 1 year I again became a PsA, otherwise I have only Staphylococcus. My doctor read about a new therapy for the eradication of PsA, I want to know if you also have success with that.
I get 500mg tablets Ciprofloxacin, Azithromycin tablets and tobramycin to inhale for 3 weeks. Before, I did never take Azithromycin - macrolide antibiotics in addition. Does this therapy promises success?
Many thanks for your answer

Answer

Dear questioner,
many thanks for your very interesting question. Indeed, there are actually different schedules, which are used to eradicate Pseudomonas. These schedules are very "center-specific". The schedule, that is up to now the most efficient one, is the Danish schedule, which uses colistin 2x 1-2 million units and Ciprofloxacin for 3 weeks up to actually morely 3 months.
Lately, a bigger study has been published (Elite-study) which compared inhalative Tobramycin 2 times a day for 1 or 2 months (without any additional therapy like Ciprofloxacin): about 2/3 of patients were 2 years after this schedule (1 or 2 months of Tobramycin inhalation) free of Pseudmonas, whereas there was no difference if Tobramycin had been inhaled for 1 or 2 months. However, only few adults had been included in this study. In how far the schedules of eradication can be transferred from children to adults, remains unclear. We in Zurich, Switzerland, have also chosen a schedule with Azithromycin due to personal experience: at least 6 months of inhalation with Colistin in a monthly change with Tobramycin and 6 weeks Ciprofloxacin with extension to 3 months if Pseudmonas should be furtheron positive and Azithromycin. This schedule is based on the fact, that our patients are all adults and show in general extensive bronchiectasis and therefore the success of eradication is generally reduced. With this schedule we have quite good success concerning the eradication of Pseudmonas, but, as mentioned, there is actually only the ELITE-scheme (Tobramycin 2x300mg for one month) which has really shown strictly scientifically that with that, 2/3 of patients are free of Pseudmonas 2 years afterwards. It is therefore possible, that the additional intake of Azithromycin does not help, to improve the success of the eradication.
Yours sincerely,
Dr. med. M. Hofer,
adult CF-clinic
universiy hospital of Zurich, Switzerland

20.04.2010