Our kids are with Dr. Nancy O'Hara and Dr. Gail Szakacs in Wilton CT for PANDAS, they have us try to increase antibiotics with a flare for example my son is in 2 tablets of Augmentin per day so if we sense a flare is starting we increase to 3 tablets per day for 5 days and we stay in touch with them, for our daughter who is well maintained on Zithromax she normally takes 250 mg per day but if we sense a flare we increase to 500 mg per day for 5 days and we stay in touch with the doctor.
Is he also on antifungals, they help.
Is he also on probiotics? Our kids are on 100 - 200 Billion, needs to be pretty high mostly in Bifido and Lactobacillus strains.
Having said all that however we get our worst OCD about 5 days after a flare.Dr. Bouboulis (Darein CT, where my kids get IVIG) says that the post viral OCD means the body is doing it's job, he says it's a healthy response which I have to say still drives us crazy sometimes, what we look for is whether our instances of OCD are getting shorter. OCD used to be 2-3 weeks long back before we started treatment, now OCD is usually just 4-5 days for my son, or sometimes for my daughter just 1 day.
Are you sure he has strep or is he reacting to other factors, a lot of kids are reacting to pollen allergens and to especially food right now, treating allergies and changing the diet even for a short time can lower the burden -- for example I need to be GF for tree pollen season otherwise I get wicked stomach aches so do my 2 PANDAS kids.
Interesting article about how berberine fights strep
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC175870/
Change his food, reduce sugar, epsom salt soak in the bath daily, reduce allergens in his home especially the bedding, sleep environment. Hope it helps.