Augmentin Taper

[bigmighty]

DS has been in a full remission for over a year. Zero symptoms. No recollection of ever having been sick. He has continued to take prophylactic Augmentin to keep from getting strep - first Aug 875 twice daily, then cut down to Aug 500 twice daily. He has been on Aug 500 for the past five months. Today, he switched to Aug 250 and it was immediately apparent that all symptoms were returning. Quickly increased the dose and hoping to stabilize things ASAP. Guess we didn't realize just how important the anti-inflammatory properties of Augmentin were in DS's "remission." Are there folks out there who just continue with antibiotics indefinitely? We had anticipated him going off entirely this summer, but that seems to be out of the question. Perhaps, this summer, he can try Aug 500 in the daytime and Aug 250 at night? Any BTDT wisdom out there? WWYD? Thanks.

[MomWithOCDSon]

We also tapered down and ultimately off Augmentin (in our case, predominantly XR, but we did switch to the non-extended release as we tapered, since breaking the XR in half negates its extended release properties anyway). We ultimately wound up keeping our DS on full strength for nearly 2 years, however, because of exactly what you've described: significant regression whenever we diminished the dose (in our case, we could set our calendar by Day 8 after reduction, which was when we'd see the behaviors really blossom).

 

At the 2-year point, though, we decided to try weaning again, and did it very slowly, over the course of about 6 months. We did see some minor regressive behaviors on occassion following a reduction, but unlike before, he was able to "snap back" relatively quickly and smoothly, like a good, strong rubber band rather than an old, worn out one like he'd exemplified before.

 

So, I guess I'd say if the regressions are not excessive in magnitude or length, you might be okay to just hold with the newly reduced dose for a bit until it "settles out" and he snaps back fully to himself. However, if the behaviors return in all their technicolor glory, I'd be concerned that perhaps it's too early to try and wean him and he continues to need the support the abx give him, whether that be anti-inflammatory or glutamate modulatory or whatever.

 

Good luck! We've been off abx for about 18 months now, so it can work out, but timing is everything!

[bigmighty]

Thanks, Nancy. I guess I really thought that the inflammation would have gone by now. So it surprised us how fast things returned. Going back to the 500 until school is out. Then thinking of switching to 500 in the daytime and 250 at bedtime to see what happens. Also thinking of talking to the doc about another steroid taper to see if we can get rid of the inflammation once and for all. We'll see what she says. Hoping not to go backwards at this point.

[MomWithOCDSon]

Just FYI, beta-lactam abx (which Augmentin is) are not really known for anti-inflammatory properties as are some other classes of abx. So it might not necessarily be inflammation. Have you had an opportunity to read that recent paper by Dr. Najiir? B-lactams are under study for their glutamate-modulating properties, and excess glutamate is thought to play a role in a number of psychiatric behavior sets.

[bigmighty]

Thanks - can you steer me towards that paper?

[bigmighty]

So - are there things other than, or possibly preferable to, Augmentin that modulate glutamate?

[MomWithOCDSon]

Thanks - can you steer me towards that paper?

 

Did you find it yet? A recent thread titled "Just Published" here on the forum. There are a number of other papers, as well, on this topic and several older threads here, too, regarding glutamate as a number of us have been very interested in it for a while now.

[MomWithOCDSon]

So - are there things other than, or possibly preferable to, Augmentin that modulate glutamate?

 

I don't know if there are other meds/supplements that are necessarily preferable to beta-lactam abx for glutamate modulation, but there are some that are OTC and/or more commonly used for the purpose and perhaps more likely to be prescribed by docs than abx. NAC works for some, but not all, of our kids. Melatonin is another glutamate modulator. Some docs prescribe riluzole, lamogitrine and/or namenda for those properties, as well. It's a fairly deep topic and makes up a large research sector right now for brain-related conditions, including autism, schizophrenia, OCD, bipolar and MS.

[lmi1973]

So glad I saw this, this topic is really relevant to what I'm going through right now. I had contacted you, bigmighty, recently because my son had started a steroid taper like the one your son had, and his symptoms went way up (ocd ramped up, anxiety/insomnia). But, I realized mid last week that I had started slacking on giving the augmentin xr twice a day. when he is in school, I ended up giving him only one dose vs. two a day bc I wanted him to have probiotics in between. Once I made the correlation with the decrease in dosage and the deterioration in his behavior/ramp in ocd and anxiety I started to make sure that he was getting his full dose again and, sure enough, within about 5-6 days of taking his full dose, he is almost back to where he was before he went downhill. I was thinking the same thing, that ok, he must have some sort of infection still (maybe he does, although bloodwork is not showing anything right now), or, the augmentin xr is anti-inflammatory properties, but, now I wonder if it is somehow modulating the glutamate...? anyway, I am now going to make sure that he gets his full dose every day!!!

[bigmighty]

Hi LauraMary. Hope things keep heading back in the right direction. DS is nearly back to normal about 10 days out from the one-day reduced dose.