Positive rapid today; on Keflex

[TracyRee]

DS started complaining about a sore throat last night and looked awful this morning. Off we go to walk in. Positive rapid.

 

He's been on daily antibiotics since December, for the last several months he's been taking 250mg Keflex 2x/day.

He's 57lbs.

 

 

What now?? He's getting strep on Keflex??

 

The walk in clinic prescribed 250mg azithromycin 1x/day. I put a email out to our pandas friendly practitioner, but it's usually a wait for a week situation there.

 

What should my plan be here? I'm at a loss as I was going on the assumption that the Keflex would keep him from getting strep.

 

 

[bigmighty]

Gosh. I am so sorry. No idea. At that weight, the 250 mg dose of keflex seems good. I'd think about doubling it, but not without checking with the doc. DS was on keflex 250 about 2 yrs ago at 77 pounds, and they doubled it when he got strep, then just decided to keep him at the 500 mg level. DS's problems went away when they switched him to Augmentin. Have y'all already gone that route? Again, so sorry he is dealing w/strep again, but very glad you caught it so quickly. Hugs.

[Mayzoo]

Wait on the pandas friendly doc's advice for maintenance meds, but definitely retest for strep when the azith is gone. Do not assume it went away with the azith. My kiddo had strep for almost 60 days and she was being treated and retested all 60 days, so keep retesting until rapid is negative, then culture to be sure it is gone.

Edited August 8, 2013 by Mayzoo

[TracyRee]

Thanks. I will let you know what pandas friendly doc says if/when I hear.

 

Will definitely retest after zithromycin.

 

We tried Augmenting this spring and he just couldn't tolerate it. He threw up or had a terribly upset stomach every day no matter how much he ate with it. (It's hard to get any food in him, so it was just so hard)

[SSS]

My dd recently came down with Impetigo (had not been on antibiotics)

she is 58 pounds, and was prescribed Keflex 500 mg 2x a day- for 10 days.

Edited August 8, 2013 by S & S

[911RN]

Is he allergic to Penicillin? If not, I would suggest a one time Bicillin injection. I believe this is one of the most under utilized methods to treat Strep avoiding use of oral antibiotics.

[TracyRee]

Thanks all. His pandas friendly doctor isn't getting back with me. I'm so tired of not having help when he needs it!!!

 

Shopping a new doctor now.

 

In the here and now though, is the azithromycin for 5 days followed by throat swab at our pediatrician all I can be doing? I can't see any other options. I do have augmentin I can try again??

[JoyBop]

I would also inquire a out doubling the dose if you don't consider switching to Augmentin. We are treating dd for strep and she was on Zithromax. We are doing 10 days of Keflex at 500mg twice a day and then taking it down to 250 mg twice a day long term. She is 4 and weighs 40 lbs. I am in the same boat and know how upsetting and frustrating it is. Did you get a positive culture or rapid?

[TracyRee]

Thanks. It was a positive rapid. Why do you ask? (Just curious)

[JoyBop]

Often times the rapid will be negative but the culture will be positive. The culture catches what the rapid can miss and is more accurate. I am told there are not usually false positives on the rapids. That is why the doc will usually wait for the result of the rapid and if it is neg will take another culture to send out. Quite often a child will not test positive while on antibiotics just be a use the strep bacteria is in hiding deep within the tissue. This would however be a false negative. Only the titres that have risen significantly and other bloodwork would be indicative of a new infection. In some ways you are lucky you were able to confirm with the rapid. In still waiting to hear if my daughters culture is positive but our ID dr wants to treat for if il even if its negative for the reasons I just mentioned.

Edited August 12, 2013 by JoyBop