Emily's last really nasty exacerbation also turned into pneumonia. She was also on a high dose of Bactrim for 3wks (we treat her staph symptomatically) and they added zithromax for 10 days, since that can help with some of the atypical pneumonia strains and prednisone. She ended up on the pred. for a couple weeks; it was a really nasty illness for her and her baseline has been a little worse for the most part ever since. She's been on zithromax m/w/f since then for inflammation, and I don't know how that affects using it for bugs like pneumonia once you are on it long-term. We have been addressing the baseline symptoms with changing up her nebs and are considering adding HTS next. Emily has not yet cultured PA. She did culture a strange pseudomonas recently, but it was not of the aeruginosa strain; it was one that was sensitive to orals and we haven't seen it the last 2 cultures.
I hate the thought of abx when not symptomatic. It seems to go both ways on whether or not to treat certain bugs when not sick; the centers that feel the way they do have strong opinions either way and will turn to whatever studies back up their pov... it's hard to know for <i>sure</i> which stance is correct. It's a fine line- we want to keep our kids as healthy as possible, to discourage damage, yet not encourage drug resistance either. I don't think there is one right answer for everyone.
Our personal experience: Emily has been culturing staph at most visits since dx, and she cultures it whether she's been on abx recently or not. She was on whopping doses of multiple meds (oral and iv) this spring and summer and still cultured it just a few weeks after coming off the meds. It is now resistant to almost all oral abx, so I don't like the idea of treating all the time and losing sensitivity to what still works. But if her baseline symptoms kept worsening or if her upcoming ct scan looks worse than what they expect it to (her xray shows only mild changes), we'd obviously have to revisit that.