Antibiotic for lung infection

[Shrimpy-13-22-25]

Latest sputum test shows coliform in lungs. Does anyone know the best way to treat this? I’ve been given oral antibiotics but some website indicate that intravenous is the only way to get rid.

[Hidden]

Depends which country you reside I'd say.

If an NHS patient you will get prescribed according to the books and recommended by NICE.

BMJ has a pdf download which may give some more info on treatment etc.

jcp.bmj.com/content/jclinpa...

From what I understand you will be prescribed the antibiotic to treat the bug in your lungs and since its already been identified you likely will have the correct AB.

If you live anywhere other than the UK, treatment options will vary (likely at patients own expense - although going private in UK may give you more choices of course)

In relation to Pseudomonas

blf.org.uk/search/site/coli....

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Coliforms are a class of bacteria, not a specific type. Common coliforms are citrobacter, enterobacter, and klebsiella species, with E Coli being the most well known, although rarely found in the lungs. Some don’t require treatment unless patients are symptomatic, including many of the citrobacters, but klebsiellas will often be treated when cultured. There are oral options available for these bacteria, the issue tends to be increasing resistance, particularly with citrobacter. Ciprofloxacin remains quite effective for many of the coliform species, but other drugs like cotrimoxazole can also be effective depending on the specific bacteria involved. When bacteria are cultured in the U.K., they’re automatically assessed for antibiotic sensitivity, so unless there is evidence that it won’t work based on historical infections and previous treatment, you should have been prescribed an oral antibiotic the testing showed the bacteria was sensitive to. The caveat to that is we know that what works in the lab doesn’t always work in vivo, so sensitivity analysis should be used as a guide rather than taken as gospel in conditions like bronchiectasis.

Pseudomonas is categorically not a coliform, so I’m not sure why the page on PA comes up on the BLF site in Bkin’s reply. PA is a different kettle of fish entirely, and would have been clearly identified via testing, rather than simply telling you it was a coliform.

[Shrimpy-13-22-25 in reply to Hidden]

Thanks Charlie-G. Most helpful. Just waiting for antibiotics (Co-Amoxiclav) to take effect. Ref BLF site and pseudomonas, that confused me too. Having had pseudomonas a few years ago I know how dangerous it can be. It showed again in sputum test last month with moderate growth and I was prescribed Clarithromycin, on the bronchiectasis pathway. Thankfully I’ve had clear sputum results since until heavy growth of mixed coliforms showed up in test. I find the wording - Provision of advice, assessment or treatment limited due to coronavirus disease 19 caused by severe acute respiratory syndrome coronavirus 2 pandemic (situation) (Y22b6) - a little unnerving. Are respiratory patients having the best treatment, or is it limited due to coronavirus?

[Hidden in reply to Shrimpy-13-22-25]

Do you mean clarithromycin or do you mean ciprofloxacin? Although I’m not medically qualified, I can tell you with absolute certainty that clarithromycin is categorically NOT effective against pseudo. At all. The only oral antibiotic for it is cipro, regardless of underlying diagnosis, with doxycycline having some limited efficacy, but usually used as a ‘holding’ drug whilst organising IVs in patients where they have resistance to cipro and the PA needs treating (in patients with known chronic infection, it’s not always appropriate or necessary to treat if it shows up in culture but there’s no change in symptoms). It’s only dangerous really in immunocompromised patients, for most lung patients it’s ‘just’ a persistent pain in the bum that has an impact on maintaining lung function, and one that requires long term management if/when it becomes a chronic infection. Once it has taken up long term residence, management is usually nebulised antibiotics to keep the bacteria suppressed. If you had a recent growth of PA and it’s the first in a while, and assuming you didn’t mistype the antibiotic they gave you, I would be going back to them as this needs treating. Are you experiencing increased symptoms at the moment? If so, in my opinion, it’s far more likely to be that causing trouble than coliforms. Or at least the coliforms on their own.

Re. care during the pandemic, I’m not well placed to say, in so far as cf patients are generally ‘top of the tree’ in terms of management. It has still caused some issues with my daughter’s care, namely monitoring her lung function in between admissions and accessing clinic, but she has received a fairly good standard of care throughout, including multiple admissions for IVs. From what I’ve seen here on the boards, lack of access to spirometry has been the main issue that keeps cropping up, but most people with bronch and the more productive chest issues seem to have been able to access care reasonably well otherwise if under a respiratory team or specialist.

[Shrimpy-13-22-25 in reply to Hidden]

Thanks again Charlie. I did try and get nebuliser Bramitob (Tobramycin) as that was the only medication that cleared it before, but was informed that my surgery had taken advice and had to go down the bronchiectasis pathway. My lungs have been clear on two tests since, so it looks as if it’s cleared up on own, then I get the coliform infection.I’m so glad that your daughter is getting the care that she needs, and I wish her well.

[Hidden in reply to Shrimpy-13-22-25]

You are really not getting anything close to good care. Tobramycin is not a treatment for acute infection: I’m glad it helped, but the people looking after you - including those ‘advising’ your GP -don’t appear to have the first clue about what they’re doing. If you’d rather not take my word for how poorly you’re being looked after, Google the British Thoracic Society Guidelines for bronchiectasis and have a good read. Table 6 in the guidelines stipulates the current antibiotic best practice for managing various infections in non cf bronch. For pseudomonas, it’s cipro, end of, unless frequent, at which point it’s cipro with nebs for longer term management, with further cipro on top to treat any additional flares. Interestingly, for coliforms, it also says to prescribe cipro as the preferred first line. Unless whatever you have is cipro resistant, it would appear that your gp is doing whatever the hell they want, potentially guided by a consultant somewhere who doesn’t have the first clue. As said before, GPs definitely don’t have the first clue: at the bare minimum, they should be using the BTS guidelines to manage you, but ideally your care should be being lead by an experienced consultant with special interest to ensure you’re receiving the right treatment.

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Please listen to Charlie. What he says about the ignorance and wayward haphazardness of those treating you is spot on. They are misinterpreting results, prescribing the wrong antibiotics for the wrong purposes and generally putting your bronch management at risk

[Shrimpy-13-22-25 in reply to Hidden]

I certainly listen to Charlie and am concerned about the treatment I’m receiving.

[Hidden in reply to Shrimpy-13-22-25]

In my opinion, when they talk about the bronchiectasis ‘pathway’ they are leading you down the yellow brick road. My consultant co wrote the bronchiectasis guidelines that Charlie quoted. I think time has come to get yourself a really good bronchiectasis consultant who can guide your GP to proper treatment. X

[Shrimpy-13-22-25]

How? There is a backlog of 500 patients just to see a respiratory doctor, and then added to that are the new referrals. The response from the lead clinician at my local Trust is - this patient will have to wait for an apt in chronological order and this patients appointment is not urgent. That was back in March. Any advise?