Pseudomonas … to treat or not ?

Possibly increase airway clearance to 3 or 4 times daily and test again. You may get the numbers down to rare or a few. I did ABX therapy with a few pseudomonas found prio to treatment. After an URI, culture came back moderate so I increased my clearance nebs and will repeat cultures.

If you are feeling sick from Pseudomonas and exacerbated then my understanding is that treatment may help to knock it back. It will not get rid of it but usually will knock it back for a period of time so you feel better. Your choice is oral (Cipro or Levaquin again) and/or Toby inhaled or IV antibiotics. If you are not feeling sick etc then saline and airway clearance etc is your best bet. They do treat Pseudo not to cure it but to decrease it.

I had NTM IN 2002 & was treated for 18 months. Developed bronchiectasis and had 8 exacerbations (pseudomonas infections) during 2024 & was treated each time with levaquin. I went to NJH in Aug 2025 for one week evaluation & was placed on brinsupri. Dr Goldstein explained that I should be treated with levaquin if pseudomonas infection causes problems. Even though it has colonized your lungs, You dont want it to overwhelm your system. When my mucus gets yellow & thick & I can feel my breathing is affected, I get a sputum sample checked to see if it is positive for pseudomonas - if it is I get treated with levaquin. There are times when the sputum will not reveal pseudomonas & then I dont get levaquin. I just have to be vigilant with nebulizing & clearing lungs

@robot have your cultures shown heavy pseudomonas? That’s what mine show each time. Recently after 4 months on Brinsupri have have significantly less mucous, don’t feel gunky and have a hard time bringing up mucous which used to be a lot. Trying to decide if it has lessened or whether I just need to work harder to clear it.

@sharonednaramsey
Sometimes pseudomonas was medium & sometimes heavy - but always treated with levaquin. Change in mucus viscosity must have to do with brinsupri. As long as i use nebulizer sodium chloride & albuterol followed by aerobika using the monometer to watch the force of blowing out - i’m pretty sure my lungs get cleared each time. But, of course, bronchiectasis just fills them up again in 24 hrs & i repeat the process.

@sharonednaramsey
Just yesterday I spoke with my Pulmo Specialist. Knowing that I am starting Brinsupri, he brought up the lessening of sputum issue saying there is no evidence that Brinsupri is making it harder to get the mucus up but rather it is decreasing the production of it. He brought it up as if that had become an issue or question with other patients. There was one person on this forum who mentioned that their CT showed plugs after being on Brinsupri but otherwise no one has mentioned that? I should think if it is decreasing the need to cough up as much mucus that one would also be feeling better.

@irenea8 Irene....not sure if you have posted how often you change the tube on the compressor to the neb cup. I think many people change it in different lengths of time of use.
I run the compressor for a few minutes to hopefully dry it out. I never thought about it until today....what could possibly grow in the tube????
Barbara

@blm1007blm1007
I believe that NJH had recommended changing it every two weeks? So I have always done that. But most people do not change it very often given the expense. I always have active infection so I just prefer every two weeks.

@irenea8 Yes I did see that about NJH and the tubing. Well I haven't been doing that but I may start the every two weeks. Sometimes I think in many things they have to error on the side of caution, that I do believe in, and the two weeks is erring on the side of caution. We really don't know for sure if we are fully drying out the tubing each time we run the compressor, without the cup attached, to push out the moisture out after completing the nebulization.
Yes...talk about expense. When I first started nebulizing with the RX coupon the 60 files were around $4.00 and change. Last year $10..00 and change. Now $60.00. All from Walgreens.
I wonder if that is the best price for this year for most of us...$60.00.
Barbara

I have pseudomonas on my last two cultures. I am allergic to Cipro, so my NJH doctor does not want to treat it at this time. I don't know what it feels like to be sick from it. Can anyone tell me that? I have not been sick except for a bladder infection from which I am now recovering. I have a very mild case of BE, but I have not been sick since my diagnosis. If I were to get sick, I think both my local pulmonologist and the one from NJH would treat me. It was mentioned that they might have to put me in the hospital for two weeks of antibiotics. I certainly hope that doesn't happen. I am so thankful for this site and all of you out there. Roz