Pseudomonas treatment

franzie2984 · Nov 18, 2011

Hi, I guess I cultured Pseudomonas for what is pretty much the first time. I did culture it once in 2006 but didn't have treatment and *supposedly* haven't cultured it since. The problem is that I am currently doing treatment for MAC 3x weekly (ethambutol, azithromycin, avelox). My CF doctor prescribed tobi 2x per day and also a massive does of Cipro 750mg 3x per day (for 2 weeks, I have not yet begun treatment) What is typical treatment does for first time culture of Pseudomonas? I feel like this is an excessive amount of medication to take. The largest amount of Cipro I have taken is 500mg 2x per day and that was without other antibiotics. I have never taken Tobi and I have never had IV meds or anything very strong. I am also small = 110lbs. I feel overwhelmed by all of these recent antibiotics. I really haven't done much lung wise until the last 2 years. Always had high PFTS, no problems. Thanks for any input or just anything you have to say about culturing Pseudomonas since it is relatively new to me! Sarah~

franzie2984 · Nov 18, 2011

Hi, I guess I cultured Pseudomonas for what is pretty much the first time. I did culture it once in 2006 but didn't have treatment and *supposedly* haven't cultured it since. The problem is that I am currently doing treatment for MAC 3x weekly (ethambutol, azithromycin, avelox). My CF doctor prescribed tobi 2x per day and also a massive does of Cipro 750mg 3x per day (for 2 weeks, I have not yet begun treatment) What is typical treatment does for first time culture of Pseudomonas? I feel like this is an excessive amount of medication to take. The largest amount of Cipro I have taken is 500mg 2x per day and that was without other antibiotics. I have never taken Tobi and I have never had IV meds or anything very strong. I am also small = 110lbs. I feel overwhelmed by all of these recent antibiotics. I really haven't done much lung wise until the last 2 years. Always had high PFTS, no problems. Thanks for any input or just anything you have to say about culturing Pseudomonas since it is relatively new to me! Sarah~

franzie2984 · Nov 18, 2011

Hi, I guess I cultured Pseudomonas for what is pretty much the first time. I did culture it once in 2006 but didn't have treatment and *supposedly* haven't cultured it since. The problem is that I am currently doing treatment for MAC 3x weekly (ethambutol, azithromycin, avelox). My CF doctor prescribed tobi 2x per day and also a massive does of Cipro 750mg 3x per day (for 2 weeks, I have not yet begun treatment) What is typical treatment does for first time culture of Pseudomonas? I feel like this is an excessive amount of medication to take. The largest amount of Cipro I have taken is 500mg 2x per day and that was without other antibiotics. I have never taken Tobi and I have never had IV meds or anything very strong. I am also small = 110lbs. I feel overwhelmed by all of these recent antibiotics. I really haven't done much lung wise until the last 2 years. Always had high PFTS, no problems. Thanks for any input or just anything you have to say about culturing Pseudomonas since it is relatively new to me! Sarah~

sunshine39656 · Nov 18, 2011

I'm in pretty much the same boat as you are. I'm 32; I think I've cultered it for a couple of years but it never bothered me until this past year when I caught a virus it didn't agree with. I've done very well with Cayston. I also take Azithromycin on a daily basis - 1 every morning. Right now, I'm taking Tobi but it's hard to take (or I think so). So far in the past 5 months I've taken limited antibiotics as long as I'm doing my albuterol, HTS and Pulmozyme. I'm hoping it will stay that way <img src="i/expressions/face-icon-small-smile.gif" border="0">

But to answer your question, I'm not sure there's a "typical" treatment because this bacteria affects different people in different ways. What does everyone else think? If there's a better treatment, I'm all ears (or eyes, rather!)!

sunshine39656 · Nov 18, 2011

I'm in pretty much the same boat as you are. I'm 32; I think I've cultered it for a couple of years but it never bothered me until this past year when I caught a virus it didn't agree with. I've done very well with Cayston. I also take Azithromycin on a daily basis - 1 every morning. Right now, I'm taking Tobi but it's hard to take (or I think so). So far in the past 5 months I've taken limited antibiotics as long as I'm doing my albuterol, HTS and Pulmozyme. I'm hoping it will stay that way <img src="i/expressions/face-icon-small-smile.gif" border="0">

But to answer your question, I'm not sure there's a "typical" treatment because this bacteria affects different people in different ways. What does everyone else think? If there's a better treatment, I'm all ears (or eyes, rather!)!

sunshine39656 · Nov 18, 2011

I'm in pretty much the same boat as you are. I'm 32; I think I've cultered it for a couple of years but it never bothered me until this past year when I caught a virus it didn't agree with. I've done very well with Cayston. I also take Azithromycin on a daily basis - 1 every morning. Right now, I'm taking Tobi but it's hard to take (or I think so). So far in the past 5 months I've taken limited antibiotics as long as I'm doing my albuterol, HTS and Pulmozyme. I'm hoping it will stay that way <img src="i/expressions/face-icon-small-smile.gif" border="0">

But to answer your question, I'm not sure there's a "typical" treatment because this bacteria affects different people in different ways. What does everyone else think? If there's a better treatment, I'm all ears (or eyes, rather!)!

ymikhale · Nov 18, 2011

I am not sure about Cipro dosing, but from what I know Tobi+ 2 weeks of Cipro is quite typical. It gor rid of my dd's PA twice ;-). Thenumber of cycles of TOBI varies though, and there is no consensus whether this number should be culture based or fixed. We did 3 rounds even though PA was gone from the cultures after the first round.

ymikhale · Nov 18, 2011

I am not sure about Cipro dosing, but from what I know Tobi+ 2 weeks of Cipro is quite typical. It gor rid of my dd's PA twice ;-). Thenumber of cycles of TOBI varies though, and there is no consensus whether this number should be culture based or fixed. We did 3 rounds even though PA was gone from the cultures after the first round.

ymikhale · Nov 18, 2011

I am not sure about Cipro dosing, but from what I know Tobi+ 2 weeks of Cipro is quite typical. It gor rid of my dd's PA twice ;-). Thenumber of cycles of TOBI varies though, and there is no consensus whether this number should be culture based or fixed. We did 3 rounds even though PA was gone from the cultures after the first round.

Havoc · Nov 18, 2011

Yikes, that is a buttload of Cipro. It is within the treatment protocol for severe respiratory infections, however. Keep an eye on that as people sometimes do not do well with Cipro. Leg pain and tendonitis sometimes with rupture. C-diff can also be a problem. It is a good drug for Pseudomonas, though.

I guess there always could be a "better" treatment, but the goal usually is to treat with the lowest level antibiotics that you are still sensitive to.

To that end, if you are uncomfortable with large doses of Cipro in addition to the antibiotics you are already on, maybe suggest to your doc to try the Tobi first, and then add Cipro if that doesn't do the trick. Also, Azithromycin, has been shown in clinical studies to reduce the prevalence of Pseudomonas in the active phases of their life cycle by as much as 80%. Still, other studies suggest that it can predispose you to MAC, but you already have that. Perhaps armed with this information, approach your doc and ask them to, at the very least, explain their rationale for such an aggressive antibiotic course, and maybe modify it based on your concerns.

Here is the link for the azithromycin study that suggests it works on Pseudomonas:
http://www.ncbi.nlm.nih.gov/pubmed/16100186

Here is the link for the study that suggests that azithromycin may make you more susceptible to mycobacterias:
http://www.ncbi.nlm.nih.gov/pubmed/21804191

I hope this helps.

Havoc · Nov 18, 2011

Yikes, that is a buttload of Cipro. It is within the treatment protocol for severe respiratory infections, however. Keep an eye on that as people sometimes do not do well with Cipro. Leg pain and tendonitis sometimes with rupture. C-diff can also be a problem. It is a good drug for Pseudomonas, though.

I guess there always could be a "better" treatment, but the goal usually is to treat with the lowest level antibiotics that you are still sensitive to.

To that end, if you are uncomfortable with large doses of Cipro in addition to the antibiotics you are already on, maybe suggest to your doc to try the Tobi first, and then add Cipro if that doesn't do the trick. Also, Azithromycin, has been shown in clinical studies to reduce the prevalence of Pseudomonas in the active phases of their life cycle by as much as 80%. Still, other studies suggest that it can predispose you to MAC, but you already have that. Perhaps armed with this information, approach your doc and ask them to, at the very least, explain their rationale for such an aggressive antibiotic course, and maybe modify it based on your concerns.

Here is the link for the azithromycin study that suggests it works on Pseudomonas:
http://www.ncbi.nlm.nih.gov/pubmed/16100186

Here is the link for the study that suggests that azithromycin may make you more susceptible to mycobacterias:
http://www.ncbi.nlm.nih.gov/pubmed/21804191

I hope this helps.

Havoc · Nov 18, 2011

Yikes, that is a buttload of Cipro. It is within the treatment protocol for severe respiratory infections, however. Keep an eye on that as people sometimes do not do well with Cipro. Leg pain and tendonitis sometimes with rupture. C-diff can also be a problem. It is a good drug for Pseudomonas, though.

I guess there always could be a "better" treatment, but the goal usually is to treat with the lowest level antibiotics that you are still sensitive to.

To that end, if you are uncomfortable with large doses of Cipro in addition to the antibiotics you are already on, maybe suggest to your doc to try the Tobi first, and then add Cipro if that doesn't do the trick. Also, Azithromycin, has been shown in clinical studies to reduce the prevalence of Pseudomonas in the active phases of their life cycle by as much as 80%. Still, other studies suggest that it can predispose you to MAC, but you already have that. Perhaps armed with this information, approach your doc and ask them to, at the very least, explain their rationale for such an aggressive antibiotic course, and maybe modify it based on your concerns.

Here is the link for the azithromycin study that suggests it works on Pseudomonas:
http://www.ncbi.nlm.nih.gov/pubmed/16100186

Here is the link for the study that suggests that azithromycin may make you more susceptible to mycobacterias:
http://www.ncbi.nlm.nih.gov/pubmed/21804191

I hope this helps.

just1more · Nov 18, 2011

Ok, based upon prescribing guidelines there is no approved protocol for 750mg TID for Cipro. The max recommended dosage is 1500mg/day, 750mg BID.

However, a physician can prescribe anything they feel is necessary and CF patients often exceed the 'guidelines' regularly. However, there are significant risks associated with high-dose Cipro as Havoc mentioned so if you have concerns I would contact your physician before starting to discuss your concerns.

just1more · Nov 18, 2011

Ok, based upon prescribing guidelines there is no approved protocol for 750mg TID for Cipro. The max recommended dosage is 1500mg/day, 750mg BID.

However, a physician can prescribe anything they feel is necessary and CF patients often exceed the 'guidelines' regularly. However, there are significant risks associated with high-dose Cipro as Havoc mentioned so if you have concerns I would contact your physician before starting to discuss your concerns.

just1more · Nov 18, 2011

Ok, based upon prescribing guidelines there is no approved protocol for 750mg TID for Cipro. The max recommended dosage is 1500mg/day, 750mg BID.

However, a physician can prescribe anything they feel is necessary and CF patients often exceed the 'guidelines' regularly. However, there are significant risks associated with high-dose Cipro as Havoc mentioned so if you have concerns I would contact your physician before starting to discuss your concerns.

azdesertrat · Nov 18, 2011

Hi there, sorry to hear you've joined the ranks of us with pseudomonas. Honestly I don't remember what my RX's were when I came up w/PA the first time. 
I do remember it was the first time I'd ever been on Tobi. Since then, whenever I have a flare-up I'm usually put on Tobi 2X daily along w/500 mg Cipro twice a day. I've never heard of Cipro being given 3X daily in that large of a dose. If you have concerns with the dosage ask your DR. It never hurts to ask. If you buy the explanation, fine. If not I'd locate a secong opinion. Best of luck to you Sarah, take care. 'Pat'.

azdesertrat · Nov 18, 2011

Hi there, sorry to hear you've joined the ranks of us with pseudomonas. Honestly I don't remember what my RX's were when I came up w/PA the first time. 
I do remember it was the first time I'd ever been on Tobi. Since then, whenever I have a flare-up I'm usually put on Tobi 2X daily along w/500 mg Cipro twice a day. I've never heard of Cipro being given 3X daily in that large of a dose. If you have concerns with the dosage ask your DR. It never hurts to ask. If you buy the explanation, fine. If not I'd locate a secong opinion. Best of luck to you Sarah, take care. 'Pat'.

azdesertrat · Nov 18, 2011

Hi there, sorry to hear you've joined the ranks of us with pseudomonas. Honestly I don't remember what my RX's were when I came up w/PA the first time. 
I do remember it was the first time I'd ever been on Tobi. Since then, whenever I have a flare-up I'm usually put on Tobi 2X daily along w/500 mg Cipro twice a day. I've never heard of Cipro being given 3X daily in that large of a dose. If you have concerns with the dosage ask your DR. It never hurts to ask. If you buy the explanation, fine. If not I'd locate a secong opinion. Best of luck to you Sarah, take care. 'Pat'.

Havoc · Nov 18, 2011

Ohh, thank you Tom I completely overlooked the TID dose. Rx guideline can be 500-750mg, q12 for 7-14 days.

Havoc · Nov 18, 2011

Ohh, thank you Tom I completely overlooked the TID dose. Rx guideline can be 500-750mg, q12 for 7-14 days.

Pseudomonas treatment

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