Which abx would you ask for in this situation...

[monarchcat]

My four year old daughter was diagnosed last year at this time with PANDAS after having strep that didn't clear. She developed obvious OCD, which stopped after 4 weeks of treatment strength azithromycin. She's now been on 100mg/day of azithromycin as a prophylactic since then. She has been exhibiting some behaviors over the past couple weeks that are starting to worry me. No overt OCD, but some mood issues, rigidity, etc. She IS four, so some of that is to be expected, but I'm still nervous. I'm going to take her in for a throat swab tomorrow. Let's just say it's positive... what should I ask to put her on? Higher dose of azith? Could be a resistant strain, though. Augmentin? Omnicef? My ped will probably give me what I ask for, but what should that be??

 

Help! Thanks!

[JJMom39]

I was just pondering this same issue this evening. My ds8 has been on prophylactic azith for about a month now. He had a strep infection in early March and a treatment dose of azith cleared that after Omnicef did nothing. Just this morning I found out that the neighbor boy with whom he played all yesterday afternoon tested positive for strep this morning. Ds seemed a little off today, but not so much that I could say he is having symptoms, yet. I put him on a full treatment dose of azith as soon as I found out about the neighbor, and I will continue that for the next several days. But, if ds does happen to develop a strep infection, I would probably ask our ped. for clinda. Where I live (central OH) there is a high degree of resistance to azith, amox, and Omnicef. Because of that my ped's office is using clinda or Keflex for strep now. (A different dr. put ds on the Omnicef that didn't work in March.) Resistance is different in different regions though. You could ask your ped. if he/she has any info on what resistance is in your area. That might help you select the abx to try. If he/she doesn't have that information, I would feel better using something other than the standards in case of resistance. If you go with something that hasn't been used as much, maybe there would be less resistance that way?? I'm not that familiar with Keflex, but if my ped. suggested that I would be okay trying that too.

[dcmom]

Both of my girls caught strep recently while on multiple antibiotics. One was on augmentin and zithromax, one was on zithromax and rifampin- all were daily treatment doses. We put them on clindamycin and it "seems" to have done the job...

[thereishope]

I'm sorry you're having to take her in for a swab:( You know this, but I will post anyway that you might want to "remind" the doctor that she can get a false negative strep test if on prophylactics. My non-PANDAS asymptomatic daughter tested positive on a rapid recently. She was NOT on prophylatics but my PANDAS son was. The ped wanted to go with a Cephalosporin. She was saying Keflex but I chose Omnicef and requested that directions be written twice daily instead of the once daily dose that Omnicef can be given. I remembered reading, maybe it was Kayanne that posted, that Omnicef may be more effective if dosed twice a day. My PANDAS son and my other asymptomatic non-PANDAS son were all put on treatment doses of Omnicef as well as a precaution (we didn't evne take them in for swabs because they got the scripts). My husband too. My primary gave me treatement dose of keflex. My throat started hurting on Thursday. But yesterday (Sunday) it was feeling better.

 

As for clindamycin, being that your daughter is 4 like mine, she may totally throw that up in an instant. If she works well with you and taking meds, then clindamycin is a possibility...but it is bad tasting as a liquid.

 

Oh, because this might help, I live in Cincinnati, OH. For those in my area, the good news is my daughter was the doc's first postive strep in a week. We probably caught it in a different state while travelling.So, it may be dying out in our area.

Edited April 11, 2011 by Vickie

[Kayanne]

I was just pondering this same issue this evening. My ds8 has been on prophylactic azith for about a month now. He had a strep infection in early March and a treatment dose of azith cleared that after Omnicef did nothing. Just this morning I found out that the neighbor boy with whom he played all yesterday afternoon tested positive for strep this morning. Ds seemed a little off today, but not so much that I could say he is having symptoms, yet. I put him on a full treatment dose of azith as soon as I found out about the neighbor, and I will continue that for the next several days. But, if ds does happen to develop a strep infection, I would probably ask our ped. for clinda. Where I live (central OH) there is a high degree of resistance to azith, amox, and Omnicef. Because of that my ped's office is using clinda or Keflex for strep now. (A different dr. put ds on the Omnicef that didn't work in March.) Resistance is different in different regions though. You could ask your ped. if he/she has any info on what resistance is in your area. That might help you select the abx to try. If he/she doesn't have that information, I would feel better using something other than the standards in case of resistance. If you go with something that hasn't been used as much, maybe there would be less resistance that way?? I'm not that familiar with Keflex, but if my ped. suggested that I would be okay trying that too.

I think I may have asked this before...but I don't remember if it was you or if I had gotten a response. When your son was put on Omnicef in March, was it a 5 day dose or a 10 day dose?

 

Thank you.

[dcmom]

Luckily my kids can swallow pills- so the clinda was easy- but my ped said if they couldn't, take the capsule and open vs the liquid (horrible taste/smell).

 

Both girls started swallowing pills with the probiotic pearls, which are tiny, and have worked up to larger things. I strongly recommend working on this- makes life a lot easier!

[KaraM]

Have you done any blood tests? If you have, you may want to do those again, too, so you can see any trend that's happening. If you haven't, you may want to consider (especially if the culture is negative), so you can start tracking in the future.

 

On a different note, my dd8 had a negative culture, but positive blood tests. She started on treatment Zith then prophylactic. Then she started to decline even while on the Zith. We thought it was due to expsure (which it may very well have been because her brother had strep). But we have also learned recently that she tested positive for Bartonella. We started treating her for this and think we may be seeing improvement now. Have you done any testing for Lyme or other tick borne illnesses?

 

Kara

[JJMom39]

My ds was put on a 5 day course of Omnicef. Maybe that is why it did nothing for him. The dr. who prescribed it only uses 5 day courses at a time. I had two other docs tell me that a standard strep infection needs to have a 10 day course of abx, regardless of which one is being used. We have moved on from the original dr. who prescribed the Omnicef because she is so rigid in her approach.

 

I was just pondering this same issue this evening. My ds8 has been on prophylactic azith for about a month now. He had a strep infection in early March and a treatment dose of azith cleared that after Omnicef did nothing. Just this morning I found out that the neighbor boy with whom he played all yesterday afternoon tested positive for strep this morning. Ds seemed a little off today, but not so much that I could say he is having symptoms, yet. I put him on a full treatment dose of azith as soon as I found out about the neighbor, and I will continue that for the next several days. But, if ds does happen to develop a strep infection, I would probably ask our ped. for clinda. Where I live (central OH) there is a high degree of resistance to azith, amox, and Omnicef. Because of that my ped's office is using clinda or Keflex for strep now. (A different dr. put ds on the Omnicef that didn't work in March.) Resistance is different in different regions though. You could ask your ped. if he/she has any info on what resistance is in your area. That might help you select the abx to try. If he/she doesn't have that information, I would feel better using something other than the standards in case of resistance. If you go with something that hasn't been used as much, maybe there would be less resistance that way?? I'm not that familiar with Keflex, but if my ped. suggested that I would be okay trying that too.

I think I may have asked this before...but I don't remember if it was you or if I had gotten a response. When your son was put on Omnicef in March, was it a 5 day dose or a 10 day dose?

 

Thank you.

[butterflymom]

=

Edited October 5, 2015 by tampicc

[thereishope]

Granted my husband is an adult, but when he went to the dr on Thursday and requested Omnicef, the dr looked up how long to dose it for and said 7 days for strep. So, my husband got a 7 day script. My kids (who go to a ped) got a 10 day script.

 

The information on 'Up to Date' (an online resource for doctors) on PANDAS, concludes that a 5 day course of cefdinir may be sufficient to treat onset, i think. It mentions Dr. Murphy's studies of cefdinir, I think. We took my son to the ER with his onset of strange movements, and the doc their read 'Up to Date' and gave us the 5 days of cefdinir, and told us to follow up with our Pediatrician. I went to our ped and BEGGED and did get an additional 20 days for him at that time.

[Kayanne]

It's my opinion (obviously not worth much since I'm not a doctor) that a 5 day course of Omnicef is the reason my daughter got PANDAS. It is approved for 5 days of treatment. In 2009, it was the first thing my daughter was put on. Eight days later, she was back in the office and still testing positive. She was then put on 10 days of amox -- a step back in strength and can't reach the intra-cellular strep. When my pediatrician had heard that the Omnicef didn't take care of the strep, he said something along the lines of, "We've been seeing some treatment failures with this."

 

I was dead set against ever trying Omnicef again, but it was offered to us a year later when she was on pen vk as a prophylaxis, all my other kids were positive for strep, she was negative even though her PANDAS symptoms were ramping up. I took the script because I was grateful for a different class of antibiotics from the penicillins, and this pediatrician told me about splitting it into 2 doses, and she was given it for 10 days -- 50mg more than the typical dose.

 

We definitely saw improvements within a few days on that treatment, and the prednisone brought her back fully.

 

I have come across different websites that say different things about it's duration and dosing (once a day or twice a day), most of the time, if strep is mentioned, they suggest a 5-10 day course. But I think for PANDAS kids, 5 days is just not going to cut it.

[monarchcat]

Thanks, guys, this is all good info. She was negative on the rapid (no real surprise there) and despite my saying, "I would like a real "old-fashioined" 72 hour culture... you know where they actually grow it in a dish?" I think the nurse still just did the 24 hour DNA thing. If that's positive I'll ask for omnicef, at least 10 days, good strength, 2x a day dosing. If it's negative, I think I'll just watch and wait... it COULD be just normal 4 year old behavior. It's definitely not the clear-cut, obvious OCD we saw last year. Or, of course, it could be negative because she's on abx. It's funny, we were thinking she would be coming off the prophylaxis soon (per Dr. ... now I'm not so sure.