Prophylactic antibiotic therapy

Question

In my son (22 months) the illness of CF is known for nearly one year. Up to now, he has not been especially susceptable for infections. He has had 3 viral infections in the last winter (rhinitis, light obstructive bronchitis, one time with short period of fever). The pediatrician and the CF-clinic agreed, that this had been "only" viral infections without involvement of bacteria. The CF-clinic however tries to persuade me that an antibiotic therapy is prophylactically necessary with a bronchitis even at an obvious viral infection, in order to avoid damage to the lung in any case.
In general, I am very cautious with antibiotics, as I have seen in myself but also in familiar children, how antibiotics can destroy the flora of the gut and make the child even more susceptible for the next infection.
How are the opinions concerning prophylactic antibiotic therapy?
Many thanks in andvance

Answer

Dear questioner,
you report, that in your child only 3 light, according to your pediatrician common colds, have been appeared in the last 12 months. The physicians of your CF-center did recommend to you an accompanying possibly named as prophylactical antibiotic therapy. You worry about possible side-effects e.g. to the flora of the gut with such a prophylactic antibiotic therapy.

As it is known to you, it is of very important relevance for the prognosis of a CF patient, to protect the lung from any damage. It is known from many studies, that viral infections of the upper airways in CF patients are very often forerunners for the from it developing bacterial infections of the lung. Therefore, under CF specialists, there is the rule of the recommendation to the parents, that in case of infections of the upper airways (rhinitis, cough, sore throat) and in case of infections accompanied with fever, in case the symptoms last longer than 2 days, that then a prophylactic antibiotic therapy should be initiated with a drug, that should be adjusted to the individual situation of the child.
At the choice of the drug, one has to pay of course attention to tolerance and possible side-effects. Every antibiotic therapy that comes too late, can cause a creeping or also a dramatic progress of the damage of the lung in CF patients. Even with all entitled fear of negative effects of an antibiotic therapy, it has to be the rule for CF patients, that the risks of a missed in-time antibiotic therapy are decisive greater than the possible risks of a prophylactic and probably unnecessary conducted therapy. The recommendation of your CF doctors has therefore to be fully supported.
We wish you much luck and an at most stable course of the health of your child.
Yours sincerely
Dr. Posselt

25.06.2009