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Pain/ partially fever under antibiotics

Question
Hello,
I am 25 years old and have for 23 years now a constant colonization with Pseudomonas. Since then, I inhale constantly antibiotics, since 1995 I do 3-4 i.v.-therapies a year, in between Ciprofloxacin in a 2-weeks on/off therapy. In former times this was not a problem to me, I was able to life my normal life more or less during the therapies. For about 2 years now I have, however, differing side-effects according to the drug, like fever, strong headache and pain in the limbs, fatigue and partially erratic mood swings. These stop one or two days after the end of the i.v.-therapy. At the same time my CRP is always increased and is partially after the i.v.-therapy higher than before. For 2 months I take 2x600 mgs of Ibuprofen daily, the inflammatory parameters have become a bit better. Nobody can or is willing to explain the thing with the antibiotics to me, slowly my acceptance of the i.v.-therapy decreases. Can one react allergic to antibiotics in general (I have tested meanwhile 6 different ones), e.g. on the dead bacteria? Or is the reason that I take some for so long time in high-dosage?
Answer
Dear questioner,
many thanks for your interesting question. I understand very well your upset about the fact that the i.v.- antibiotic therapies do not have the same effect as in former times and that you have increased "side-effects" such as fever, headache and pain in the limbs. However, I do not believe, that you turned to be allergic to one of the antibiotics or even that you have been treated too long in high-dosage. The main problem is possibly that the bronchiectasis in your lungs worsened clearly in the course of the years, in spite of the for sure correct therapy, and the effect of the antibiotics is not as good as it used to be. This is above all in connection with the fact, that the bronchi widened due to the chronic infection (=bronchiectasis) and therefore actually an accumulation of "pus" (very high inflammatoric secretion which contains above all inflammatory cells and bacteria) in the airways took place. The antibiotics can only very poorly kill the bacteria in this "lake of pus", as they cannot reach those and therefore have more and more less effect. Of course it would be very helpful in this situation, in case it has not already been done, to perform a CT-scan of the lungs, in order to see, how the lungs look like and if this "accumulation of pus" causes a problem. Besides the regular i.v.-therapy, you should for sure continue the regular, daily physiotherapy for mobilization of secretions and also the inhalative antibiotic therapy, but I suggest, that you already do so.
In priciple, there arises the question of a lung transplantation dependent of the progress of the illness. This should be discussed individually with a CF-competent doctor. Probably you alreday discussed this with your CF-physicians in charge.
Dr. med Markus Hofer
04.10.2010