Non-nebulised antibiotic treatment
Oral antibiotic treatment – prophylaxis
“All young children with CF identified by newborn screening or diagnosed clinically should be started on anti-staphylococcal antibiotic prophylaxis with Flucloxacillin until 3 years of age” (CF Trust 2009)
Children of any age may receive long term oral antibiotics to prevent infection with common bacteria. Typical drugs include:
- Augmentin duo (syrup) – twice daily
- Augmentin (tablets) – twice daily
- Cotrimoxazole tab/syrup twice daily
- Doxycycline tab once daily
- Flucloxacillin (tablet/syrup) –twice daily
- Azithromycin (tablet) – once daily or three times per week
Oral antibiotics - treatment
Slight changes in symptoms are treated with additional oral antibiotics. Typical symptoms include:
- Increased / change in / productive cough
- Changes in the appearance / volume of sputum
- Decreased exercise tolerance
- Loss of appetite
- Absence from school/work
- New signs on chest auscultation
- New changes on chest x-ray
- Fever
- Fall in lung function
Intravenous antibiotics
The decision to commence intravenous antibiotics is made jointly with patient/parent/clinician once oral treatments have failed to bring about an improvement. Persisting low grade symptoms such as a cough alone is an indication for IVAB (CF Trust 2009).
There is a low threshold to commence IV treatment. The timing of the intravenous antibiotics can be influenced by life events (exams, holidays), frequency and timing of previous antibiotics, lung function, microbiology results, nutritional state, microbiology results, etc.
Courses of antibiotics are usually started in hospital but if frequent courses are needed children may prefer to have this treatment at home if it is the only reason they are staying in hospital. Lines used are temporary in the hand or arm (including long lines) or permanently indwelling e.g. portacath and courses generally last 2 weeks. Long term daily IV antibiotics are rarely used. Parents are taught how to care for lines, prepare and administer the treatments using Aseptic Non Touch Technique (ANTT). In some areas disposable infusion systems are used, they are light, do not require batteries and can be worn under clothes. Time taken to set up and connect one of these would be up to 15 minutes per dose. In other areas the parent has to mix the antibiotics and set up the infusion themselves. Typically the decision to give a course of IV treatment is decided, a date agreed, prescription taken to pharmacy, treatment dispensed and the parents usually give the first dose in the department where the line has been inserted. The process takes a whole day if episode is unplanned. Once home the parents have to store all of the treatment and equipment safely, prepare 2 antibiotics to administer three times daily usually at 0800, 1600 and 0000 or times around these to fit in with their other commitments. Each administration can take 45-60 minutes. Time taken depends on equipment provided, type of venous access and experience of the parent/carer. Portacaths require monthly flushing using aseptic non touch techniques whether antibiotic treatment is being given or not.
