Jan, 2001. Viral respiratory infections [online]. Seacroft and St James's University Hospitals, Leeds, UK. Available from http://www.cysticfibrosismedicine.com

When the CF patient develops a new viral infection, an extra antibiotic should be considered as an addition to long term Staph prophylaxis. This antibiotic should be active against H. influenzae and S. pneumoniae, e.g., amoxycillin (Amoxil), cefaclor (Distaclor) trimethoprim (Monotrim), azithromycin (Zithromax), erythromycin (Erythroped) or clarithromycin (Klaricid). The Copenhagen experience clearly documents an increased incidence of new P. aeruginosa acquisition in the winter months (Johansen & Hoiby, 1992). Respiratory viruses are associated with pulmonary exacerbations and more severe symptoms in adult patients (Pond et al, 1996). All viral infections should be vigorously treated (Pond & Conway, 1996). An extra antibiotic is taken with every cold and started before the patient becomes chesty or signs are heard in the chest. The extra treatment is continued until the patient returns to his/her previous condition even if this takes two or three weeks. If the new symptoms (most important being a new cough) do not settle with the extra antibiotic the patient is seen in the CF clinic. The extra antibiotic may be changed, further cultures taken and a chest X-ray arranged. It is not unusual for there to be new X-ray signs which require more aggressive treatment, e.g., a course of intravenous antibiotics.

For more details see CF (UK) Trust antibiotic consensus section

References

Johansen HK, Hoiby N. Seasonal onset of initial colonisation and chronic infection with Pseudomonas aeruginosa in patients with cystic fibrosis. Thorax 1992; 47: 109-111

Pond MN, Conway SP. Co-infection with respiratory viruses results in more severe pulmonary exacerbations in adults with CF. Israel J Med Sci 1996; 32(Suppl): S259.

Pond MN, Conway SP. Respiratory viruses, but not atypical bacteria, are associated with pulmonary exacerbations in adults with CF. Israel J Med Sci 1996; 32(Suppl): S258

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