Strep on Augmentin

[Agnes26]

DD8 was back to 99 percent at the start of school three weeks ago. She is on treatment rx of Augmentin ES.

 

Then on 8/14 school called to report a confirm case of strep and another. 8/15 DD begins to have noticeable PANDAS symptoms (anxiety/emotional lability/irritatibility/ocd), which improve over the weekend with ibuprofen. Symptoms increase all this week as more cases of strep are reported. Ibuprofen doesn't seem to be helping. Last night was bad. DD telling me OCD is repeating in her head and she's having intrusive suicidal thoughts. She doesn't want to kill herself, but OCD is telling her to. I call neurologist this morning to ask for steroid burst. Still waiting for a call back when school calls. DD is sick with 101.7 fever, headache, joint pain and sore throat.

 

I mean. It's strep, right? I don't need a culture to tell me that. School nurse says that's all parents are calling in sick with.

 

I don't know what to do. Our ped is out today. Do I bring her into the practice and hope she cultures positive and we get another doctor who is PANDAS friendly? I'm guessing she'll culture negative. She's only ever cultured positive once and she's on the treatment rx of Augmentin. I once asked our per what would happen if DD got strep on the Augmentin, and she said she'd take her off it and put her on something else. I'm terrified of DD off Augmentin? Anyone on Augmentin and something else? And where does the steroid burst fit into all this? Our PANDAS doc is Murphy.

 

 

[T_Anna]

You can add Azithromycin with Augmentin. Maybe try a walk-in clinic, I've heard that they are more likely to prescribe abx. When DS caught Strep while on Augmentin last year we were given Clindamycin which I believe is good for fighting strep and can be combined with Refampin (another thread on the forum at the moment). But Azithromycin is popular with clinics and it would buy some time at least (you can say that your child has a drug eruption to Amox.).

 

T.Anna

[Hayley]

my DD NEVER in her life cultured positive until this May (when she got strep on Augmentin) and then again last month (when she got it while on Omnicef). First time she had a rash, but no symptoms (she'd been at a point where we called her 100% about 98% of the time -- the exception being little "blips" about once a month); Second time she woke up with anxiety and said her underwear felt wet (a telltale sign of hers we hadn't seen since she was at her worst) and her throat hurt). When she got strep on Augmentin they switched her to Omnicef and that kicked it. When she got it on Omnicef they switched her to Rifampin which worked as well.

[Agnes26]

Pinch-hitting doctor said it was likely strep no matter what the culture says. She called our ped, who said to pull her off Augmentin (she's been on it for over a year) and do a 10-day course of Cefzil. I'm terrified to switch and would prefer to add.

 

Has anyone had success with Cefzil?

 

Ironically, DD seems like her OCD has abated since the fever arrived.

[bigmighty]

Any chance of just increasing the dose of Aug for a few days? What would the doc say about that?

[Agnes26]

Any chance of just increasing the dose of Aug for a few days? What would the doc say about that?

 

I wish, but doctor says she's on the max dose: Augmentin ES 600 2 tsp./day.

[airial95]

My son has often tested positive for strep even while on abx. He has tested + while on treatment doses of Augmentin, Azith and cefdinir individually, and also while on 500 mg Augmentin 2x day AND 250 mg Azith 1x day (he was 4 at the time and about 35 lbs). At that time we added rifampin and he has done well on the triple combo.

 

I see that even the ped agrees that it's likely strep - but another thing to remember is that many PANDAS kids also react to others around them even if they do not get infected themselves. Since it's the immune response to strep causing the problems, any exposure to strep can trigger the immune response, even if they don't catch the bug themselves. And exposure to strep can happen 24-72 hours before someone even comes down with any physical symptoms (sore throat, fever, etc...) My son was the proverbialy "canary in a coal mine" and would start to flare 2 days before we would get the first notification - fortunately, if he managed to not get re-infected, those flares only lasted about 5 days before they began to subside...but they sucked none the less.

 

We have it written into both kids 504 plans that they are allowed excused absences when there is strep prevalent in the classroom and make up work is allowed during that time. We used that twice last year in my daughter's class when strep was epidemic (3-4 cases/week it seemed!)

[Agnes26]

My son has often tested positive for strep even while on abx. He has tested + while on treatment doses of Augmentin, Azith and cefdinir individually, and also while on 500 mg Augmentin 2x day AND 250 mg Azith 1x day (he was 4 at the time and about 35 lbs). At that time we added rifampin and he has done well on the triple combo.

 

I see that even the ped agrees that it's likely strep - but another thing to remember is that many PANDAS kids also react to others around them even if they do not get infected themselves. Since it's the immune response to strep causing the problems, any exposure to strep can trigger the immune response, even if they don't catch the bug themselves. And exposure to strep can happen 24-72 hours before someone even comes down with any physical symptoms (sore throat, fever, etc...) My son was the proverbialy "canary in a coal mine" and would start to flare 2 days before we would get the first notification - fortunately, if he managed to not get re-infected, those flares only lasted about 5 days before they began to subside...but they sucked none the less.

 

We have it written into both kids 504 plans that they are allowed excused absences when there is strep prevalent in the classroom and make up work is allowed during that time. We used that twice last year in my daughter's class when strep was epidemic (3-4 cases/week it seemed!)

My daughter is also a canary. Definitely has the autoimmune response to others infected with strep. That's what we thought was going on here auto-immune neuro symptoms, but then she came down with a fever. That's not auto-immune, right?

 

In a related head-scratcher, I discovered the doctor rx'ed the lowest dose of Cefzil. How does it make any sense to trade a high dose antibiotic for a low dose one? I will switch, but let's make it apples to apples. Geez.