Should 4+ Pseudomonas be treated?

I’m seeing Pseudomonas as a hot topic lately on the various Bronchiectasis and NTM online forums. Some of the European guidelines recommend early eradication and many doctors follow that approach. But there are other doctors who don’t believe in treating it.

I had this discussion with my NYC doctor who is a specialist NTM and bronchiectasis. She said if I were to culture Pseudomonas that she would start treatment right away. Not even wait for second culture. That’s why I get regular sputum samples.

According to a recent ATS talk by Drs. Chalmers and Blasi, often when we first get Pseudomonas we have no symptoms. So I opt to be proactive with this difficult to kill bug. I think I cleared MAC and prefer not to have any other pathogens taking up residence in my diseased lungs:)

The best of health to everyone,
Linda Esposito

My ID doc is also aggressive when it comes to treating pseudomonas, even when colony counts are low. One of the things that gives me hope is recent and ongoing research about how to make pseudomonas more vulnerable to antibiotics and immune surveillance, by interfering with biofilm formation, efflux pumps, and quorum sensing. Enzymes, herbal meds, pharmaceuticals, and other substances have shown promise, at least in petri dishes. Much more research is needed, including human testing. Numerous entries on Pubmed and other sites. How to safely deliver these substances to the lungs could be a huge challenge.

Hi Wolf, what is colony counts are low? 1+, 2+ etc? I too have drug resistant Burkholderia cepecia and very hard to eradicate. I'm using garlic and manuka honey as (they kill this bug on petri dishes) and thyme leaves.

Hi Sweet.

The lab used by the Cleveland Clinic doesn't have a number scale rating. The descriptions I have seen so far are "Rare - insignificant colony count, no further workup," "Rare" (by itself), and "Moderate." I'm assuming there is also a high count.
Gonna get some garlic and manuka honey. They are also on the list of substances shown to inhibit bug biofilms, at least in the lab. Ginger extract is also on the list, as is green tea extract and rosemary. Keep at it!

In response to @becleartoday …. I have had only 2 sputum cultures since diagnosis in 2018 and have never been informed of any cultures. One culture came back through test results as 2+ positive. I have not had symptoms and the Mayo pulmonologist is see has never addressed this type of issue. I find your approach and doctor’s input very interesting.

There was recently a very comprehensive article by Anne O’Donnell on bronchiectasis in the New England Journal of Medicine. She recommends regular sputum testing so as to be proactive if a patient should have an infection without symptoms. You can get the article by signing up with the journal for two free articles. I have also written to NEJM for permission to put it online.

I used maluka honey when being treated for a nasty leg wound by a wound care doctor. I wish we could put it on our diseased lungs! I assume you are eating it and wonder how it gets into the lungs.

Please share how much manuka honey you take ?? daily? Thanks.

Hi fdixon63, I got 20UMF 830MGO manuka honey. I take half teaspoon with chopped a raw garlic twice (one clove) a day in May. My culture went down from 2+ to 1+ (not sure it has to do with this or not). I stopped in July & August and my culture went up to 2+ again. So, I will take it again. I'm just testing to see if Manuka and garlic can help destroy biofilms in my lungs (many papers stated it killed on the lab dish).

Researchers are finding a way to deliver molecules of this honey into the lungs. I don't know where I read it but it is for CF patients. I'm still not sure how eating would get into the lungs or really helping or not. I'm just believing that it will help build WBC to fight off the infection/bug.