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Infection in case of CF, even once possible without antibiotic?

Question
Dear expert team,
my question: Can/should/is it allowed for a child with CF to get through an infection with increased cough even once without the intake of an antibiotic?
There are controversing opinions about this. Some of the doctors advise immediately an antibiotic drug, others are rather for waiting, if the general condition during the infection (and of course also before) is good.
Could there be possibly any long-term consequences if the child goes once through an infection without antbiotics, say if it thus coughs strongly once in a wihle for 14 days?
Or are there any long-term consequences, if it gets antibiotics always with any cough (resistances...)?
Many thanks for your opinion.
Answer
Hello,
you ask, if an antibiotic therapy has always to be performed in case of a CF child with an infection with increased cough, or if one can also wait for 14 days in case of good general condition. You also ask about long-term consequences in case of an omitted antibiotic therapy.
In general the recommendation for CF children pertains, that in case of any infection that goes along with increased cough, that lasts longer than 3 days and in case of infections with fever and cough, a sore throat and/or markedly increased secretion in the nose-throat area, an antibiotic therapy should be started. For sure many infections that start like this, are at first caused by viruses, whereby those infections are then the precursor for a bacterial inflammation and furthermore it is a prophylactic measure, that should avoid a secondary bacterial infection in case of an at first started viral infection.
In case of an infection with increased cough you are waiting e.g. 14 days because of a good general condition, the fact that your child has a good general condition does not give you security, that in spite of this there has been lung damage. I always try to describe this problem to the parents with the example of the car paint. If the car has been to the car wash once, you will hardly see any traces on the car paint. However after 10 or more visitis to the car wash, you will indeed see a bunch of little scratches on the car paint. This is similar to infection in CF. A sole, not optimally treated infection does often not lead to a marked deterioration of the general health condition. In case of many of those infections, it comes indeed to a deterioration of the lung function with lasting, visible damage. This creeping process we have to avoid with a consequent treatment.
Of course, a frequently performed antibiotic therapy has also negative effects. In the long runs this can lead to resistance of the present bacteria. Also each antibiotic therapy leads to a change in the gut flora. Therefore, in CF children, one should perform from time to time a therapy with probiotics, in order to support the rebuilding of the good gut flora.
As the positive effects exceed markedly the negative effects in case of an aggressive antibiotic therapy, an antibiotic drug should rather be used several times too often than once too less.
Therefore stay on the safe side! If one comes to the conclusion after a trial of leaving out the antibiotic, that a negative effect did occur, it is too late.
Best regards,
Dr. H.-G. Posselt
03.12.2014