Response from Dr. about increasing abx dosage and ibuprofen

[JulieMc]

Hi, we suspect PANDAS in my 6 y.o. son and just started abx a few days ago. He weighs 50lbs and was started on 200mg/5ml every OTHER day. After reading posts here, I sent her an e-mail last night about considering increasing the dosage to 250mg every day. This is the response I got. Dr. Stewart is another doctor in her office and he will do every day. What do you think?

 

"Azythromycin has very long half life. That is why it is used for the"Z-pac" When you finish the five days of a Z-pac you have effective blood levels of anti-biotic for 10 day. To give Azythromycin every-day is possibly toxic to the liver. I prefer the every other day dosing because I know with this anti-biotic that his blood levels are the same on the off day as on the on day. We can increase the dose--to 250 if that is an acceptable compromise. Since Dr. Stewart does the everyday dosing I can do that too but I am not as happy about it. Ibuprophen twice a day is possibly dangerous to the kidneys. I would not mind a short course of this but I would not want it to overlap with the Azythormycin."

 

We live near Austin, TX so if there are any recs for PANDAS specialists here, I would love to hear them. Or maybe I need to switch to Dr. Stewart which I had been considering anyway.

[peglem]

Hi, we suspect PANDAS in my 6 y.o. son and just started abx a few days ago. He weighs 50lbs and was started on 200mg/5ml every OTHER day. After reading posts here, I sent her an e-mail last night about considering increasing the dosage to 250mg every day. This is the response I got. Dr. Stewart is another doctor in her office and he will do every day. What do you think?

 

"Azythromycin has very long half life. That is why it is used for the"Z-pac" When you finish the five days of a Z-pac you have effective blood levels of anti-biotic for 10 day. To give Azythromycin every-day is possibly toxic to the liver. I prefer the every other day dosing because I know with this anti-biotic that his blood levels are the same on the off day as on the on day. We can increase the dose--to 250 if that is an acceptable compromise. Since Dr. Stewart does the everyday dosing I can do that too but I am not as happy about it. Ibuprophen twice a day is possibly dangerous to the kidneys. I would not mind a short course of this but I would not want it to overlap with the Azythormycin."

 

We live near Austin, TX so if there are any recs for PANDAS specialists here, I would love to hear them. Or maybe I need to switch to Dr. Stewart which I had been considering anyway.

Did you start with a "loading dose" of zith? The zpack does this, then the subsequent doses maintain levels over time. Your doc is right that zith has a long half life. I'd go for the 250/day(starting w/ a 500 loading dose) until you see symptom improvement and then drop to every other day to maintain. My pediatrician is very vigilant about liver/kidney toxicity too. I do appreciate that though. We check liver/kidney function about every 6 months just to be careful. Never had a problem there, and my daughter gets a lot more ibuprofen than 2x/day.

Edited February 4, 2011 by peglem

[JulieMc]

Did you start with a "loading dose" of zith? The zpack does this, then the subsequent doses maintain levels over time. Your doc is right that zith has a long half life. I'd go for the 250/day(starting w/ a 500 loading dose) until you see symptom improvement and then drop to every other day to maintain. My pediatrician is very vigilant about liver/kidney toxicity too. I do appreciate that though. We check liver/kidney function about every 6 months just to be careful. Never had a problem there, and my daughter gets a lot more ibuprofen than 2x/day.

 

Peggy, no, we didn't start with a loading dose. I think I will ask her about doing it every day until we see symptom improvement like you said and also about checking the functions. You have been so very helpful, thank you so much!!

[browneyesmom]

Hi Julie... how is your son doing? If he's doing fine and you are seeing improvements, I may leave it as is. However, if he is not improving, I would certainly go for daily dosing until he does, then you might consider dropping it to every other day.

 

My dd11 has had elevated liver function tests for several weeks and they are watching her carefully to try to bring the levels down. It can be tough sometimes to find the right balance; I hope he is doing better soon!

[JulieMc]

Hi Julie... how is your son doing? If he's doing fine and you are seeing improvements, I may leave it as is. However, if he is not improving, I would certainly go for daily dosing until he does, then you might consider dropping it to every other day.

 

My dd11 has had elevated liver function tests for several weeks and they are watching her carefully to try to bring the levels down. It can be tough sometimes to find the right balance; I hope he is doing better soon!

 

We are only on day 4 of the Azythromycin (so total of 8 days) and haven't seen any changes yet. I e-mailed the doc about some of these issues and haven't heard back from her yet. Thank you for sharing your experience and I hope your daughter's liver improves quickly.

[Fixit]

You can give milk thistle to help detox liver..

 

dropp it in a little water..pretty blan

[JulieMc]

You can give milk thistle to help detox liver..

 

dropp it in a little water..pretty blan

 

Thank you! Yes, I already give him Milk Thistle so that will help for sure. The doc said that if we do daily antibiotics she wants to check liver function monthly. At least she is open to giving it to him daily.