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Augmentin vs Zith


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I need to do an update soon, but things are still in flux...

 

My daughter has been on zithromax for about 1.5 years straight, daily, for pandas. Initially, it put her in remission, later we needed to do immunosuppressive treatment. She continues on a daily dose to prevent strep and other illness, and frankly because I am afraid to take her off.

 

We recently added augmentin twice a day- for possible lyme- with no change whatsoever.

 

I am considering moving forward with pandas treatment only (not interested in discussion on this heated topic right now).

 

So, for you pandas parents: what do you think of 2x daily augmentin vs daily zith. Is there a benefit to either? Is there a benefit to changing it up, or keeping things the same?

 

Does anyone add or change antibiotics when kids have or exposed to viral illness, or if they see a flare up of symptoms?

 

My other daughter is allergic to penicillin- so we are keeping her on zith for now.

 

Thanks!

 

PS: my computer broke a few months ago, just replaced it today! So, I have been typing on my Iphone- that is why I have been long to reply, and short on words :) Can be a little more present now.

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My ds started Augmentin in Oct 2009. Initially we saw slow, steady progress. However, Fall 2010 He seemed to have plateaued. He switched to Zith in Dec and we saw further progress. He was switched by our immunologist. Our neurologist commented that zith was better for inflammation bug augmentin is better strep protection. I asked about doing both. She didn't want to do that because he is better than his baseline and was concerned there wouldn't be anything left to use if he really needed it.

 

My dd takes Augmentin. Initially seemed to progress but has been steadily losing ground after getting sick and brother having the flu. Made a little progress after steroid taper but now worse than when she started augmentin in Oct. She gets her tonsils out on Monday so I'm praying that helps.

 

Hope that helps.

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Because you are on the east coast and there are some resistant strains of strep lurking around (to azith)...my vote would be Augmentin for strep prophylaxis.

My boys have been on it and are doing well with it. 2 x a day sounds good to me.

 

I don't do anything different with the antibiotics with a viral illness, unless I see a big enough flair (a small flair I would just wait out)...I will up it for about 5 days just in case. It does usually help things settle.

 

Best wishes to you.

 

kelly

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We did do a month of Augmentin XR b/c some of the docs dh talked to when he was back East thought it made sense to switch for a while (resistance??). Also, since we hadn't tried it, we wondered if it could push us closer to 100% (we're pretty good...90-95%, but some learning issues, ocd, movements, remain). It didn't seem to help (vs. Azith.). Maybe that is our baseline after years of PANDAS...or maybe dd just needs more time to heal.

 

Our ped did think Augmentin was more likely to give us yeast issues. Also, we found the 1x daily Azith. MUCH more easier (and if you miss a day, you're not in big trouble).

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We have found great success with Azith. But we did recently increase dose, and found much better results - maybe a weight thing. We only use every other day, sort of a pulse theory, I suppose, but it does allow us to easily increase when she is ill - and that seems to make a difference.

 

Hope you find some good answers soon.

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Kelly (or anyone)

 

Can you elaborate on the East coast strep strain thing? I mean, I understand how it can start out that way at a specific point in time, but why would a certain strain of strep stay in one area in such a fluid society for bacteria passed human to human?

 

I wonder if this is still true? It seems many of the docs, east coast included, are favoring zith lately.

 

Does anybody else think this may no longer be the case or no longer specific to the East Coast?

 

Thanks!

Jill

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Jill,

 

In Swedo's original study.....it was recommended to use Penicillin over Azith because of resistant strains of strep in the East coast. It would be my assumption that it could easily spread...meaning that the resistance is more widespread now. Or, could it have burned out..(if there is such a thing)? I can tell you that we all had strep when this mess started. My husband had to take Azith because of a Penicillin allergy (suspected..not confirmed..but, taking no chance)...anyway, the Azith failed to eradicate the strep in him......docs chaulked it up to resistance and put him on Clindamycin. So, I have seen it happen here first hand. Can't answer your questions for sure...but, I personally would not feel comfortable using Azith as a strep prophylaxis. We haven been doing either Penicillin or Augmentin for 4 years now and have had no breakthrough strep. I don't know about other docs...but, Latimer suggests Augmentin for us.

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Hey Kel-If it ain't broke, don't fix it!!!!

 

Can anyone who has recently (past year) had strep break through on prophylactic Zithro please post here? And also please post where you're located?

 

We got it on Augmentin, but the dose was too low.

 

Thanks!

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We just had a breakthrough with Azith for DS6 (Jack). My other DS6 (Nick) is on Augmentin. He got sick (and so did I) within a week after visiting the east coast! Not sure if we got it there or perhaps on the plane? But it makes sense there was most likely a connection. My DS6 on Augmentin never got sick! We kept Jack on the Azith and added Penicillan. Seems to have worked, we are having him rechecked this week. My plan is to now take him off the Penicillan and stay with the Azith. It has worked so well for us for almost 2 years I don't want to mess with it.

 

Kari

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Can anyone who has recently (past year) had strep break through on prophylactic Zithro please post here? And also please post where you're located?

 

We got it on Augmentin, but the dose was too low.

 

Hi Jag10...good idea. Could people also (if there was a break through) if their PANDAS child actually

 

1) cultured positive and if the strep (sore throat, fever?) was otherwise symptomatic...or if there was just PANDAS symptom increase, which could be exposure, not necessarily infection

 

2) the dose/frequency of Azith. (and weight of their child) at the time of the breakthrough

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My 9 year old son has been on 2x daily augmentin since Nov. 2009. We just moved him down to once daily less than 1 week ago. If he does get a bacterial infection, treatment will depend on what type of infection we think it is.

 

Keep in mind that no antibiotic is perfect. While my doctors prefer augmentin as a strep preventative because there are zith resistant strains of strep here, mycoplasma is resistant to augmentin and is treated with zithromax. Its a catch-22.

Edited by Debbie1
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Kelly (or anyone)

 

Can you elaborate on the East coast strep strain thing? I mean, I understand how it can start out that way at a specific point in time, but why would a certain strain of strep stay in one area in such a fluid society for bacteria passed human to human?

 

I wonder if this is still true? It seems many of the docs, east coast included, are favoring zith lately.

 

Does anybody else think this may no longer be the case or no longer specific to the East Coast?

 

Thanks!

Jill

 

Jill,

 

Here is an article about it in Pittsburgh. I live only 4 hours East of Pittsburgh, so once a rheumatologist at Hershey told me about macrolide resistance, I have avoided azith. My daughter had a PANDAS exacerbation while taking Pen vk, so I don't trust that either.

 

She now takes 150mg of Omnicef. My pediatrician believes the cephalosporin class of antibiotics is better for strep than penicillins and macrolides. However, he is not the prescribing doctor. Our PANDAS neurologist is.

 

http://query.nytimes.com/gst/fullpage.html?res=9E00E2DA173FF93BA25757C0A9649C8B63

 

Although, I should add that my strep was finally kicked (after trying amoxicillin twice) by 2 z-packs. So, I don't think originally it was a macrolide resistant strain that hit our house in 2009.

Edited by Kayanne
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Thanks, Karen!

 

This article is from 2002 and the studies were prior to that. I pulled out this quote:

 

"But erythromycin-resistant strep has been seen at very high rates in several European countries and in Japan. ''We've talked about this for years,'' Dr. Martin said, ''and now it's here. We can't sit back and say, 'Not us.' It's clearly here.''

 

I just can't see why "here" would only apply to the East Coast? If it can get from Finland and Japan to the East Coast surely in the past decade it's made its way to the Golden Coast, no? I mean, just on this thread of 8 families Kari took zith-resistant strep back to CA, right?

 

The article also said the less macrolides are prescribed in a community, the incidence of macrolide resistant strep drops significantly. Do most East Coast docs have a habit of over-prescribing macrolides more than their mid-west and west coast counterparts?

 

 

 

 

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