Report Puffy face with Bactrim in PANS / PANDAS (Lyme included) Posted June 13, 2011 I see my girls severe insomnia and some of her OCD going away with the bactrim, but she is quite aggressive and her face is starting to look a bit puffy. We are going to start adding in biaxin. She is being treated for Bartonella. We got done with a steroid burst about a week and 1/2 ago. Do you think the puffy face is someting to be concerned about? She has been working up to the full dose for 15 days so far. Do many kids get aggressive for awhile on the treatment and then gradually get betteer?