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Which antibiotic?

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I am due to see the doc tomorrow to argue my case for DS getting some stronger antibiotics. We've done 20 days of penicillen. Days 5 to 10 of this were great, we saw an incredible improvement in his mood and quality of night time sleep. Extreme tiredness persisted but I wouldn't really have expected this to lift quite so quickly anyway. ASO titers have been elevated since at least nov 2011, and were still elevated at our latest test in Feb 2012.


Having had my faith in the medical profession severely battered, I want to go in with an idea of what I should get for him. My question therefore is which antibiotic? Is Azith better than cephalosporins or is there anything else better? I saw a previous thread linked to reports comparing cephalosporins to penicillen (thank you!) but how about Azith?


Thank you!

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We are trying Zithromax (azithromycin) and have been on it steadily for about 44 days. I started seeing minor improvements in two weeks. Now I would say she is back to about 90% of her normal self.


Bit of history:


DD was diagnosed with strep on 1-5. Her Pandas flare up started in Sept 2011. We did not begin treating it until 1-5. We started with Amoxicillin (one step newer than penicillin but still in the penicillin category) for ten days. Saw minor improvements on days 6 and 7, then lost them all of them the rest the ten days. We switched to Augmentin (amoxicillin + clavulaunic acid) for 10 days. Saw more very minor improvements, and did not lose them, but did not resolve the active strep infection either. We switched to Zithromax and still did not resolve the active strep in the first 5 days, so we just kept at it with the Zithromax for 30 more days before we tested again and got a negative strep test and culture.



Every kid is different, so what works for my kiddo may not work for yours

Edited by Mayzoo
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Our DAN! dr is adamant that erythromycin (zithro etc) is more effective because it is a macrolide. Amox just doesn't cut it for DS - it may keep it in check while he's on it, but as soon as he goes off it "whammo!"

Here are some links to papers to support you. Good luck!



Reduced Ability of Penicillin to Eradicate Ingested Group A Streptococci from Epithelial Cells: Clinical and Pathogenetic Implications

Edward L. Kaplan1a, Gursharan S. Chhatwal2, and Manfred Rohde2



Penicillin, Amoxicillin: Step Aside for Strep Throat Treatment

Uni of Rochester Medical Centre

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Thank you for your replies.


Our doc agreed to prescribe Azith, but only in the standard tiny dosage, just a three day course. I am concerned that this is nowhere near long enough to make any difference, especially when I read how long others need to be on it for.


I guess I just need to monitor DS very carefully and go back again with feedback re change or lack of change.


I'm so worried about the permanent damage that is being done by his strep antibodies still being elevated, especially as we are also looking at a diagnosis of narcolepsy.

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Try to breathe :)


I have two kids who were both, at different times, severely affected by pandas. They are now back to "normal". I do not think, as long as you are working on treatment, that there will be "permanent damage".


I haven't read your other posts, are you in London? Just wondering if there is a pandas specialist you can see.


My kids did daily zithromax for a long time, not only is it anti bacterial, it is also immune modulating.


We have found ibuprofen to be a great weapon in our first line of defense against pandas. If your son has symptoms, or if you see any uptick in symptoms, I would consider 5 days of regular dosing of advil (as if there were fever). And see if that helps. I do think there are a few parents here whose kids take longer term a single daily dose of ibuprofen (we have not had to do this).

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