Treatment of a long-term germ colonization

Question

I have been living with the CF diagnosis for a long time. Today, the doctors think that it is not CF but “only” COPD with bronchiectasia.

I have several infections every year which are always treated with antibiotics in tablet form (for several years now mostly cefuroxime and moxifloxacin). Often an infection does not announce itself with signs of a cold but I get a fever within a few hours and an ulcerous smell from the lungs can be detected. Correspondingly, the sputum is green.

Since the infect comes without any signs of a cold, I suspect that my lungs have been permanently colonized by germs which get the upper hand and are pushed back again with antibiotics. Due to this process, I worry about resistances.

I actually heard about a new treatment option for long-term germ colonization of the bladder: a drug (perhaps an antibiotic?) is placed directly into the bladder and its effectiveness is altered with the help of electricity. This way, the drug can reach places that are otherwise difficult to access.

My question now: Is there a similar procedure for the lungs as well?

Many thanks for your answer!

Answer

Dear questioner,

many thanks for your quite interesting question. I am a bit confused about the fact that your doctors apparently spoke of CF for a long time and now “only” of COPD with bronchiectasia. Have you ever had an extended genetic test done in order to rule out CF?

Irrespective of that, your symptoms do fit potential bronchiectasia very well. It is fairly typical for patients with bronchiectasia (whether CF or not) to suffer from fever consistently. The secretion contained in the bronchiectasia leads to local inflammatory reactions and therefore to fever attacks. A thorough drainage of the secretion (like you may have had it done in the context of your now seemingly “wrong” CF diagnosis) is very important here.

Concerning your question about local therapy in combination with electricity, no such procedure exists for the lungs, and I am not entirely clear about how such a therapy should work with bladder infections. I do think, though, that it is important in your situation to have your sputum checked for bacteria regularly, and that the actual therapy should be the same as if you had CF. This means that in case pseudomonas is detected, inhalative antibiotics therapy would certainly be helpful.

Dr. med Markus Hofer
Senior physician, adult CF clinic and rare lung diseases
Zurich University Hospital

07.09.2010