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Treatment recommendation for persistent Pseudomonas/Staphlococci infection

Question
Dear team,
I have received a lung transplantation (2010) and suffer from CF. For 6 months, my lung function decreases rapidly and since then, it is constantly low.
Antibody tests, bronchoscopy, CT and x-ray had already been done. Only in the bronchoscopy, Pseudomonas and Staphylococci could be detected. All other tests had been negative, therefore no transplant rejection.
It is still like this, that I do not have secretions, even if I inhale with hypertonic saline 6%, beta-mimectis and tobramycin.
Furhtermore I received in the last months 3 therapies with moxifloxacin and icreased cortisone (50mg prednisolone). Azithromycin is for the last 6 months my long term therapy (3 times a week).
None of all therapies brought success. The lung function stays on the low level. In former times, I did a lot of sports. This is unfortunately also a burden and no joy at all.
Would you have an idea, what the problem could be?
Many thanks in advance
Answer
Hello,
as far as I got it, Staphylcocci and Pseudomonas aeruginosa had been found in the bronchoscopy. Furthermore I understand, that until now no long term antibiotic i.v. therapy had been done against these germs. Moxifloxacin does unfortunately not help against Pseudomonas. If it is like this, and obviously a therapy against rejections (cortisone) remains without effect, first of all an i.v. therapy could make sense. Furthermore one should look for rare fungi, that could also be responsible for a worsening of the lung function.
It is always difficult from afar, to make further good diagnostic or therapeutic proposals. It would be the best to get in contact about the further treatment with your CF center.
Best regards,
R. Fischer
19.05.2017