Antibiosis treatment standards

Question

Hello,

how do you explain the fact that different clinics follow different treatment strategies? Specific example: i.v. antibiosis regularly or only when needed – see the Danish model.

Should one not assume that the standard of knowledge is the same throughout one country, or that after years of different practices it should have become clear by looking at comparative data which method ultimately is the best?

For patients, after all, these different views are quite confusing and incomprehensible.

Kind regards.

Answer

Dear questioner,

many thanks for your inquiry. I understand your uncertainty very well; however, it is often the case in medicine (and not only with CF) that there is not only “one road that leads to Rome” but that there are indeed different options. It is true that the Danish do regular i.v. therapy for patients with proven pseudomonas. On the other hand, particularly in the Anglo-Saxon countries, here in Switzerland and as far as I know also in Germany, i.v therapy is only done if a patient shows symptoms of pulmonary exacerbation. Concerning this, by the way, A. Bush of Royal Brompton Hospital in London was able to show several years ago that it does not make a difference whether a patient is treated regularly every 3 months or only when needed, and that the number of i.v. therapies administered is similar in both groups. You are nevertheless right in saying that it is important to establish so-called guidelines that serve as therapy standards, and the European CF Society has actually published important guidelines on the treatment of CF over the past years, with further ones being in development. Luckily, however, the treatment of CF has changed dramatically over the past years, and what is considered standard today could well be outdated tomorrow. It seems important to me that your treating doctors try to explain to you why they are choosing one particular treatment strategy over another, and that you also ask them about it. Like I said, concerning regular i.v. therapy with pseudomonas infection, the books are not closed and we here in Zurich usually really only treat patients if they have exacerbation. However, this requires a sound “body feeling” and a good amount of responsibilty of the patient in order to notice exacerbation early on. If a patient with exacerbation is too late rather than too early, we do actually also choose the regular i.v. schema with 3-4 monthly therapies.

I hope I could answer your question. Generally speaking, though, “ultimate, universal truths” are very rare in medicine.

Kind regards

Dr. med. Markus Hofer
Senior physician, adult CF clinic
Zurich University Hospital

The following comment was added on July 5, 2010:

An answer to the question of how often or when a patient colonized with pseudomonas aeruginosa needs antibiotics therapy has to consider medical developments, particularly the introduction of highly-dosed inhalative antibiotics therapy. Long-term treatment with a pseudomonas aeruginosa effective inhalative antibiotic influences the decision about the necessity of a "routine" (prophylactic) i.v. antibiotics therapy.

13.09.2010