Should 4+ Pseudomonas be treated?

@fdixon63 Sorry to hear you are having trouble kicking the pseudomonas. It can be tough - took my husband & me each 3 courses of different antibiotics to get rid of it, but so far no reoccurence in 2 years. I'm going to bring @windwalker into the discussion as I know she has dealt with this.
Your doctor's recommendation aligns with what some of us are seeing recently - less jumping in immediately with antibiotics when infections show up but are asymptomatic. For example, I still test positive for MAC, but have been off antibiotics for 7 months, managing only with 7% saline.
Sue

fdixon …… I too have a pseudomonas problem. I've never had a report that said 3+, 4+ or anything like that. The sputum tests I do just say "many" -- so I don't know how that falls into your category. I've been on toby for over a year and am not getting rid of them. I am discouraged about that too. I have difficulty taking it due to shortness of breath but am now doing two weeks on and two weeks off. I cough all the time -- never clear -- always green and have no trouble coughing it up whether or not I do anything. I do nebulize 3% saline twice daily and albuterol twice daily plus the toby. I'm wondering if anyone has any other med that has helped to rid pseudomonas. My doctor is with Mayo's in Rochester (for what that's worth). Appreciate all comments concerning pseudomonas.

sueinmn ……. would you be so kind as to share which antibiotics you used in treating pseudomonas in your household? I'm hoping for something besides toby in that it doesn't seem to be working for me

@auntnanny 2 different chlorquinolones, doxycycline, azithromycin & inhaled tobramycin - who knows what finally knocked it out after all of that? I was on one of the chloroquins, with the toby for 6 weeks. My husband used the other antibiotics because he cannot have chloroquins due to tendon issues.
Sue

The positive lab findings come back to show 1+ through 4+. The 4+ is the worse on the scale. First tested 1 plus in March 2019 and was given Levofloxacin. I was not tested again until Sept 2019 and had three different ?strains and all were 4+ so obvious Levofloxacin was not effective. I had a PICC line with Ciftazidime for 2 weeks and Tobramycin for 28 days. Five months later had two ?strains--one 4+ and one 3+. Given Tobramycin for 28 days. Again in March 2020 and again Tobramycin 28 days. Latest sputum results in June 2020 one 4+. Wish we could all get something to work. Urg. Thanks to everyone who is responding--more, more sharing.

sueiinmn thank you for your note. Yes, hard to tell which might have been the right one but happy for you that it worked

fdixon53 -- thank you for sharing your info...… it seems toby has not been a cure-all for you either. But you took it only 28 days and then off for several months? I had thought it was a continuous drug until pseudomonas were gone. Certainly, mine are not gone. Thank you again

The doctor did not say anything about doing more than the 28 days. That's why I reached out to the group. We all have different doctors and apparently many opinions on how to treat. Thanks to the group. We're all about caring and sharing. God bless.

@migizii I have been fortunate to not have experienced this (yet) but got an email yesterday from NTM Info & Research that had an article that new NTM guidelines have just been released. Perhaps you can find it online as I have no idea how to get it from my email to this site.....

Migizil, Here is that article. https://ntminfo.org/wp-content/uploads/2020/07/NTMguidelines2020.pdf Pseudomonas is often seen in conjunction with the various NTMs, and some of the antibiotics mentioned for NTM will also kill Pseudomonas.