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Dear expert team,
I am 42-year-old CF patient (F 508 / 2789+5G-A), however in very good general condition (FEV1 5.63 L. 98 kg body weight (athletic)). Besides 2 times daily inhalation with sole NaCl solution I do not any further therapies. Once a year, I have a control at the CF-center. Unfortunately, at the last control of the throat swab, multiresitant Staphylococci have been found. The CF-center recommends an eradication trial with fusidic acid and rifampicin or linezolin and rifampicin, as a colonization with this germ can lead to a loss of lung function. I have now 3 times used nasal ointment with mupirocin and mouth wash with octenidin (antibacterial)for a week, the germs however are still detectable. My general practitioner has concerns because of the side effects of rifampicin, I am also of this opinion, especially as I know that my stomach revolts in case of very little amounts of pain killers. What is your opinion, do you share the opinion of the CF-center? For a quick answer I thank you in advance.
Dear questioner,
you would like to know as a CF patient, if the detection of an MRSA-germ (multiresistant Staphylococcus aureus) in the thorat swab without clinical symptoms and without any deterioration of other findings (therefore MRSA-colonization and not -infection) has to be treated. At this point I recommend to you also a testing of the germ finding in the induced sputum.
In contrast to an MRSA infection that always requires a treatment, there is no unique and evidence-based recommendation for the MRSA colonization. A deterioration of the course of the illness due to an MRSA colonization has not been proofed nor, however, either been ruled out.
There are different eradication protocols, among those the by you mentioned therapeutical proposal (according to Macfarlane et al., 2007)(1). This therapeutic protocol shows a success rate of 94% and comprises a multi-step procedure:
- non-drug therapy (change of the clothes and bed clothes, the towels and disinfection of the surroundings etc.)
- mupirocin and antiseptic washings
- 5 days of antibiotics orally: rifampicin and fusidic acid (step 1)
- in case MRSA persists, then again 5 days of anitbiotics orally: rifampicin and fusidic acid (step 2)
- in case MRSA persists, then 9-13 days teicoplanin i.v. (step 3)
The other eradication possibility with linezolid/zyvoxid (a drug that can be given orally as well as i.v.) and rifampicin has also proponents.
For an eradication trial the following arguments can be found in the literature (2):
- the MRSA colonization increases the risk of an MRSA infection
- the MRSA colonization could be regarded as a contraindication for a lung transplantation
- CF-centers with several MRSA patients pose a contagion risk to other departments of the hospital
- MRSA colonized patients need a much higher organizational effort during the performance of therapy, this can result in a worse medical care

Basically in my opinion an MRSA eradication trial is very sensitive. This should be done, if possible, soon after the first finding of the germ. The sorrows about intolerance of the oral medication can via the internet not be confirmed nor taken away. For this, the physician has to know the patient personally in order to be able to make an adquate recommendation. I recommend to you to talk to your CF physician again about the topic MRSA eradication. Probably my remarks are helpful for this talk and so an optimal decision can be made for you.

I hope to have helped you with this answer,
Best regards,
Dr. Christina Smaczny

1 Macfarlane M, Leavy A, McCaughan J, Fair R, Reid AJ. Successful decolonization of methi- cillin-resistant Staphylococcus aureus in pae- diatric patients with cystic fibrosis (CF) using a three-step protocol. J Hosp Infect 2007;65: 231–236.
2 Anforderungen an die Hygiene bei der medizinischen Versorgung von Patienten mit Cystischer Fibrose (Mukoviszidose), 2012. Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch Institut, Berlin