Maintenance therapy

Question

How is the decision made whether a maintenance dosis of antibiotics is prescribed to babies and young children ?
I think that this is not done routinely?
Have there been studies in this area?
What are the pro’s en cons of maintenance antibiotics therapy ?
Why is there so little known about the correct treatment of babies ?

Answer

Dear madam,

You ask two questions. Your first question is a detailed question on maintenance therapy with antibiotics in young children and your second question is a general question about standard treatment in babies.

To answer your first question: maintenance treatment with antibiotics is prescribed to young children to prevent colonization and further infection of the airways. In young children the antibiotic will be to treat stafyloccocus, the first en most important bacteria that causes airway colonization in young children with cystic fibrosis. You are right that recent guidelines do not advocate the use of continuous antibiotic therapy in young children with cystic fibrosis when they have no signs of airway infection and when they have no colonization of bacteria in the airway. These guidelines are indeed based on studies. Previous studies have shown that prophylaxis with antibiotic does not lead to improvement of lung function in young children. So far, there is insufficient evidence to support routine use of antibiotics in young children when there is no sign of airway infection. The guideline does advocate to use antibiotics in children who have positive isolation of bacteria from the airway. It is advocated that such sampling of the airway is done at least four times a year. If a bacterium is isolated and certainly when there are signs of infection (coughing, wheezing) treatment with antibiotics is indicated. The advantages of treatment with antibiotics in young children is a decrease in the number of positive cultures. In children with proven staphylococcal infection, maintenance therapy will lead to the reduction of the number of positive cultures and a lower number of hospital admissions. The disadvantages of chronic maintenance antibiotic therapy is that antibiotics can have side effects.
In summary, to decide whether or not the child needs maintenance antibiotics therapy several factors play a role including the type of infection, the seriousness of the infection, the disease state of the lungs and the results of the cultures. That is why a decision is made on an individual basis.

Your second question refers to the fact that there is so little information on the correct treatment of babies. This is not only so for cystic fibrosis but also for asthma because studies in children younger than 5 to 6 years are difficult to do. These children cannot produce sputum and they cannot perform lung function tests which means there are few objective parameters to judge the effect of the treatment. But certainly with the advent of newborn screening more focus goes to research in newborns and young children and we expect more evidence and better guidelines for treatment in the future.

Kind regards
Dr. Anne Malfroot

14.09.2010