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ENT does not believe in pre-op ABX for T & A

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What abx did your ENT give to your child either pre-op, during, or post op? Are their any articles you have handy about this? I need to find information to try to change this ENTs mind. He acknowledges she has PANDAS, but he does not do pre, post or during ABX for autoimmune issues *sigh*. Kiddo is already on Keflex prophylaxis.

 

Thanks and I am off to google as well.

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DO NOT TAKE NO FOR AN ANSWER!!!! Our ENT refused as well. Our son, 4 at the time was Strep infected and the T&A caused a severe, acute episode. IOt took the better part of a year on daily abx to get him back (partially). Can you have Dr. T or another PANDAS specialist do a consult? DON'T agree to this surgery without a run of sterilizing abx!

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hi - if you cannot get ENT to agree to abx but feel you need to go ahead with this particular ENT and surgery, could you get another dr to rx pre and post op abx? Would this ENT agree to abx during surgery. Are abx during surgery a must if pre and post op abx are administered?

 

I agree with beeknees, I wouldn't touch a T&A without abx but JMHO.

 

I believe Dr T recommends Clindamycin and another abx(not sure which) as a sterilising pre-op combo. Not sure what the rec. is for during or after. There will be folks that know, Im sure....

Edited by dut

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We just went through this as well. Our ENT said he doesn't typically prescribe ABX before surgery, but gave up amoxicillin after. Dr T gave us a prescription for 10 days of Augmentin before. On the day of the surgery we requested the anestheologist do the IV ABX and that was no problem for them. Our son was not in a flare before the surgery and now 3 weeks post op he has been 100% fine.

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All three of my kids had tonsillectomies NOT related to PANDAS (though for my daughter who has it, we think onset was about the time her tonsils blew up to the size of baseballs..no surprise there!) and our ENT prescribed abx each time for 10 days prior. I don't recall if they got them after, but i believe they did during the surgery. All were on omnicef. I thought this was standard procedure.

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I will ask the anesthesiologist for abx during. I had not thought about that yet. The ENT said none before, after or during even though he agrees she has an autoimmune disorder. Upon a Google search, this is a new approach recommended--no abx during T & A (My link.) He is at least willing to remove them and culture them (despite his feeling a culture is a waste of time), which seems to be hard to get docs to do this now *sigh*. The pedi and the ENT says they look fine upon examination. Her strep history is:

 

09-11-2011 Strep (not confirmed), not resolved with abx

09-17-2011 Strep (not confirmed), finally resolved after another abx

1-5-2012 to 2-29-2012 constant strep for 55 days confirmed by rapid strep test every 7-10 days.

7-5-2012 strep confirmed with rapid strep test

10-20-2012 Bronchitis, pharangytis

 

We are in N-Central Texas, no where near a specialist and kiddo cannot fly due to Arnold Chiari Malformation I. So far she has been mildly to moderately affected by PANDAS since we got the first flare under control. When we can, we will make a road trip to see a specialist. We used to go to Illinois for her Chiari, but hubby is at a different job now and works 12-16 hour days every other day.

 

I believe I know a doc that will give her Clindamycin. If not, I have zithromax on hand I will probably give her zith 5 days before and 5 days after. She is already on Keflex, OLE, Ultimate Immunity, lecithin, Omega 3,6,9 and Propolis caps for immune support. She is about 80% of normal right now.

 

Thanks everyone for the input.

 

 

 

Article excerpt:

 

"Statement 8: Perioperative antibiotics

 

“Clinicians should not routinely administer or prescribe perioperative antibiotics to children undergoing tonsillectomy.”

 

Strength: Strong Recommendation"

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Our ENT also told us that the "standard" procedure now for T&A is no abx at all. However, ours then proceded to tell us that we needed to do at least 7 days post-op and IV abx during the procedure for the PANDAS itself. Both of my kids were already on abx pre-op for ongoing flares/infections - so that was a non-issue for us. But I echo everything everyone says here - if you can't get the ENT to agree - DON'T DO IT!! It's crucial for these kids.

 

Is there another ENT in your area you can consult? Ped to write the pre/post rx?

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I will ask the anesthesiologist for abx during. I had not thought about that yet. The ENT said none before, after or during even though he agrees she has an autoimmune disorder. Upon a Google search, this is a new approach recommended--no abx during T & A (My link.) He is at least willing to remove them and culture them (despite his feeling a culture is a waste of time), which seems to be hard to get docs to do this now *sigh*. The pedi and the ENT says they look fine upon examination. Her strep history is:

 

09-11-2011 Strep (not confirmed), not resolved with abx

09-17-2011 Strep (not confirmed), finally resolved after another abx

1-5-2012 to 2-29-2012 constant strep for 55 days confirmed by rapid strep test every 7-10 days.

7-5-2012 strep confirmed with rapid strep test

10-20-2012 Bronchitis, pharangytis

 

We are in N-Central Texas, no where near a specialist and kiddo cannot fly due to Arnold Chiari Malformation I. So far she has been mildly to moderately affected by PANDAS since we got the first flare under control. When we can, we will make a road trip to see a specialist. We used to go to Illinois for her Chiari, but hubby is at a different job now and works 12-16 hour days every other day.

 

I believe I know a doc that will give her Clindamycin. If not, I have zithromax on hand I will probably give her zith 5 days before and 5 days after. She is already on Keflex, OLE, Ultimate Immunity, lecithin, Omega 3,6,9 and Propolis caps for immune support. She is about 80% of normal right now.

 

Thanks everyone for the input.

 

 

 

Article excerpt:

 

"Statement 8: Perioperative antibiotics

 

“Clinicians should not routinely administer or prescribe perioperative antibiotics to children undergoing tonsillectomy.”

 

Strength: Strong Recommendation"

 

 

In the state of Texas, doctors do not have a choice about doing a culture or biopsy on any body part that is removed. It is required by law.

 

My sons adenoids and tonsils were removed by a dr who decided it didn't need to be done as well as not providing abx. BIG mistake. You should insist on the abx as mysons tics only got worse after surgery because the infection spread.

 

We later found a wonderful ENT who removed 2 polyps from my sons nose and he did iv antibiotics during as we'll as large dose abx before and after surgery. I was informed by this wonderful dr about the laws in Texas and the removal of body parts.

 

I would recommend finding another dr. Who understands pans, pandas and pitands.

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