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going to son's pre-op appt. today for upcoming T & A


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My 7 year old son is having his pre-op appointment with our ENT today for his T & A scheduled for Oct. 25th. My oldest two children had their tonsils and adenoids removed several years ago, but with a different ENT.

 

He is currently on Zithromax 250mg daily and has been on this for 23 months. After several exposures to strep over the past 2 months, I am SO SO worried about his "strep status" going into surgery in a few weeks. I seriously doubt any culture would come back positive at this point, so I am wondering what I should do about possible "left over" strep in his body.

 

My nephew recently had a T & A and even though he was on Augmentin for 3 months and zithromax prior to Augmentin, his tonsils after removal still cultured out for WBC +4, mixed anaerobes +2, and a few more that I forget. His ENT gave him an injection of penicillin during surgery (bacillin).

 

Has anyone had either IV antibiotics or antibiotic injections prior to or during their tonsillectomy?

 

When I first took him to this ENT and she saw that he was on daily antibiotics, I thought she was going to faint on the floor. She just kept saying, "UGH.. antibiotics..UGH". Gee, wonder if she would have her child on antibiotics if they had PANDAS...

 

Anyway, I feel a battle coming on. She had better not flat out refuse to do it. It is standard protocol for prophylaxis with rheumatic fever.

 

TIA.

Colleen

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My 7 year old son is having his pre-op appointment with our ENT today for his T & A scheduled for Oct. 25th. My oldest two children had their tonsils and adenoids removed several years ago, but with a different ENT.

 

He is currently on Zithromax 250mg daily and has been on this for 23 months. After several exposures to strep over the past 2 months, I am SO SO worried about his "strep status" going into surgery in a few weeks. I seriously doubt any culture would come back positive at this point, so I am wondering what I should do about possible "left over" strep in his body.

 

My nephew recently had a T & A and even though he was on Augmentin for 3 months and zithromax prior to Augmentin, his tonsils after removal still cultured out for WBC +4, mixed anaerobes +2, and a few more that I forget. His ENT gave him an injection of penicillin during surgery (bacillin).

 

Has anyone had either IV antibiotics or antibiotic injections prior to or during their tonsillectomy?

 

When I first took him to this ENT and she saw that he was on daily antibiotics, I thought she was going to faint on the floor. She just kept saying, "UGH.. antibiotics..UGH". Gee, wonder if she would have her child on antibiotics if they had PANDAS...

 

Anyway, I feel a battle coming on. She had better not flat out refuse to do it. It is standard protocol for prophylaxis with rheumatic fever.

 

TIA.

Colleen

 

ds just had ta 2 weeks ago today...

clindamycin iv..standard i believe...

and as per post by dut i think ..i read that doc t likes it before and after...and i was ready to get off of zith...

so we had clina 3x day after fro 10 days...got my dan to extend 10 more lower dose.....

he was doing do fanaminal..on high dose...i am bumping back up today to see...

it could just be the tonsils really needed to come out... or the clinda... or some sawtoothing here...

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Colleen, what did the ENT say? I am curious about your situation because ours is the same. We have a scheduled T&A and are on zithro too. I know two antibiotics can be given at the same time when needed as well. Our ENT said he does not do antibiotics before, during or after. I believe I will have to have an expert send him a letter. Let us know what happens.

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That sounds strange to me. I really thought it was just standard practice to give iv during and antibiotics for a week after. The only thing my ENT did for me that he said was not standard for him was a week pre-op of antibiotics but he had no objections to doing it.

 

 

 

Colleen, what did the ENT say? I am curious about your situation because ours is the same. We have a scheduled T&A and are on zithro too. I know two antibiotics can be given at the same time when needed as well. Our ENT said he does not do antibiotics before, during or after. I believe I will have to have an expert send him a letter. Let us know what happens.

Edited by ajcire
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Seems odd to me too - I did not love our ENT, but he prescribes 500 Azith the night before surgery with ALL kids. It IS surgery - and all surgeries have germs in them.... Not to mention what may be released from the tissues during surgery, and keeping infection out of the cut....

 

Told me to consult with Ped on keeping our changing our schedule with preventative abx, which I did and we just kept the course after a consult. We had about 12 days of PERFECT, then an unusually bad flare up that only lasted 8 days and was easily kept under control with an uptick in abx, and addition of Motrin and Benadryl. In the middle of it, she got a bad respiratory thing - we had abx so it never got bad enough for a doc.

 

When we went back to our PANDAS doc recently, and they saw this on the chart, they commented that this is a pretty normal pattern - an illness a few weeks after ENT surgery. Our dd had adnoids only (don't ask, no real clue why, doc did not want to take her tonsils, said they are fine. We don't have constant strep issues, so I let it go).

 

Good luck!

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My ENT said that she puts all of her patients on oral amoxicillin post surgery. She said she does not use IV antibiotics or antibiotic injections (shot of penicillin). When I questioned her about the fact that many ENT's use IV or injects of antibiotics with surgery, including my nephew's ENT who recently told my sister he gives all his patients a penicillin shot during surgery, she told me that she was a "hold out", meaning that she is one of the very few doctors in this area who even give antibiotics post T & A.

 

He is on daily zithromax, so I will probably increase his Zithromax a week prior to surgery. I am not thrilled about amoxicillin and may ask her to at least make it Augmentin. OR, should I push and insist on a penicillin shot?

 

I also asked her if she could culture the tonsils post surgery to see what was in them and she said she would IF my "pandas specialist" called her and told her specifically what to culture for. She said she always sends the tonsils to pathology, but they merely tell her it is free of any tumor and do not look for pathogens. When I told her my nephew had been on months of Augmentin and Zithromax and still had numerous bactria show up in his post surgery culture, she said that she would expect that b/c we have lots of germs in our mouths.

 

This was what my nephew had culture out of his tonsils post surgery.

 

Smear Result (Anaerobe Cult/Stain)

4+

WBCs

3+

Gram positive cocci

in pairs and chains

2+

Gram positive dipththeroid-like bacilli

 

Culture:

4+

Mixed anaerobes, unable to isolate for identification

 

Any thoughts? I do not think that after being on months of Aug and Zith that it is normal to still have all of this bacteria. Does anyone know what terminology to use with my ENT to explain what to do with the tonsils post surgery? Is it a "smear" and culture that i ask for? Seems like she should know. I have had really bad luck even getting in touch with Dr. T to interpret my lab results he ordered, I am afraid I will never be able to get him to call her.

Anyway, surgery is 3 weeks from tomorrow and even though I have been through it twice before with my older children, I am already getting so nervous and worried.

 

Colleen

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Is it a biopsy that I ask them to do post surgery? I asked the ent if she could culture them and she said " if the pandas specialist tells me what to culture for" and that she only sends them to pathology to make sure there is no tumor.

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DD12 had T&A July 27--had been assymptomatic since May (only a few things creeping in every now and again) Severe symptoms including sneezing tic for months. 500mg Azithr. 3x per week since Dec. Stopped Azith day before surgery and she was given iv Rocephin during proceedure. After surgery she was given omnicef 2xper day x 10 days; nystatin oral suspension 3x per day x 7 days;and pain meds. Azith was started back after 2 weeks. We requested tonsils sent off for path ENT very surprised with following: Staphylococcus Aureus(heavy), Streptococcus Viridans (moderate). They also did sensitivity studies and I have antibiotics her strain where sensitive to--interesting because I would not have seen this except for the fact that I requested path report. blood test repeated 8weeks post surgery and believe it or not the ASO was unchanged and the AntiDnaise was higher that ever before--still mostly assymptomatic. Immunologist says to just continue Azith. because she is doing well and we don't want to "rock the boat". Hmmm she doesn't realize I want to drive the boat! I want to be in control of this disease not have it control DD!. Visiting new Ped Infection Control Doc next week to see if we should change antibiotic to one that shows on her Path report (makes perfectly good sense to me) Even though she seems to be doing extremly well I would like to see infection gone out of her completly! ENT did explain he felt like tonsils where holding infection and this has helped but also the infection was in her body somewhere before the tonsils (they were just doing job) so infection must still be present. I feel grateful we have path report to work off of--- Hope this helps and good luck!

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For those of you that your doctor gave either an antibiotic shot or IV antibiotics during surgery, did your doctor give you a reason why? Did they say they do it for all of their patients? Did they say the consequences of not giving it? Did you specifically ask for it to be given?

My son is having his T&A on Monday and his ENT refuses to do antibiotics- inject or IV. She plans to give his a scrip for amoxicillin.....

Luckily, Dr. T gave me about 2 1/2 weks worth of Augmentin, but I still feel a shot of penicillin or something IV is Not overboard.

Any thoughts? I am afraid he will vomit the Augmentin. My older two kids vomited on and off for 1-2 days. If that is the case, he would not be covered by antibiotics. I will continue the zithromax up until the day before surgery and restart it as soon as he can swallow the pill, which hopefully will be after 3-4 days.

Colleen

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