Question

A 9-year-old female with cystic fibrosis presented to the pulmonary clinic with persistent exertional dyspnea and cough with scant sputum production. Physical assessment revealed normal vital signs, but she had an oxygen saturation of 91% while breathing room air. Her weight had fallen from 68.2 kg to 65.5 kg over the last 3 months. Cardiovascular assessment was completely normal. Lungs demonstrated coarse breath sounds bilaterally and were moderately decreased. The abdomen was normal, extremities demonstrated mild clubbing, and there was no peripheral edema. FEV1 had decreased from 70% to 50%. The chest radiograph resembled baseline findings with no obvious infil- trate or pneumothorax. Her standard inhaled treatment regimen was albuterol, 7% hypertonic saline, dornase alfa, and Flovent followed by vest therapy twice daily. She was prescribed a month-long course of azithromycin, aztreonam, and inhaled tobramycin for suspected pulmonary exacerbation with an acute superinfection. One month later she returned to the clinic for a follow-up visit. Physical exam re- vealed moderate improvement in dyspnea as well as her FEV1, which now was back to baseline, and her oxygen saturation improved to 95% on room air.

1. Why do you think multiple antibiotics were prescribed for this child?

Answer 1

-From the above given pulmonary general and systemic examination ,we can say Pseudomonas aeruginosa lung infections in cystic fibrosis patients.Cystic fibrosis lung infections usually occurs with Pseudomonas because of irregular mucus production and reservoirs in airways of cystic fibrosis patient's attracts gram negative bacteria and promote their growth

-With increase of resistance after exposure to various antibiotics and cross-resistance between agents may result in multidrug-resistant (MDR) P. aeruginosa. and persistent infection with P. aeruginosa leads to the sequential emergence of resistance to multiple antibiotic agents.

-To treat the infection, multiple assessments should be made about the antibiotics combination ,it is better to use multiple antibiotics with different mechanism of action and of different groups such as macrolides, aminoglycosides,Beta-lactams together as Azithromycin+Tobramycin+Aztreonam respectively as mentioned in above case. In some cases Cephalosporins may also be added.

-Thus multiple antibiotics were prescribed for the patient