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prophylactic abx dose?

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We are 2 years on Augmentin (500mg 2x day) for PANDAS/PANS and recurring strep A and B but just added clarithromycin (250mg 2x day) due to strep D infection. Boys are 70 and 79 pounds. Monthly ivig due to low IgG...

Edited by Gpookie
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DS is one year on Augmentin 875mg x 2day. Monthly IVIG. but my boy is 132 lbs - Dr. says he has to stay on this dose until symptom free for a year and then she will decrease.


The Dr. also ants to also put my dd on abx. My dd does not have PANDAS but catches Strep all the time which is a huge problem for my PANDAS son. She has brought strep home 4 times in the last 11 months! Dr first talked about a weekly Zirthromax but then was talking about a weekly Amoxicillian since that was used to treat her strep. It was my understanding that Amoxicilin stays in your body for such a short time that it would not be effective as a one dose weekly. Is anyone doing this?



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Any abx given only once a week would be very ineffective and IMO would greatly increase the risk of abx resistance. Let's say your DD gets strep again and takes one day of amox. Only a small portion of the strep bacteria would be killed and the remainder would learn how to resistant the mechanisms of amox. That;s why when you have an infection, they tell you to finish the entire course even if you feel better. Any survivors pass on survivor knowledge to their offspring.


Once your child is symptom-free, I think the most effective prophylactic schedule is this:

Days 1-5 of the month, Azith daily

Day 6, 8, 10 (even days) azith (which has a half life of 36 hrs vs. Amox which has a half life of 2? hrs)

Then at the start of the next month, do 5 days straight again, then every other day for the rest of the month.


The 5 days at the start of the month actually stays effective for the 1st 10 days (which is how a z pak gives you the same coverage as 10 days of amox) and would theoretically kill any simmering infections. Then the every other day gives you sustained coverage for the rest of the month.


Doing abx only once a week or even twice a week just seems like begging for any infection to become resistant to that abx.


Alternatively, you can read up on herbal antibiotics and use them on an as-needed basis. I've found that giving herbal tinctures at the first suspicion of illness nips things in the bud (I still give the herbs for several days after symptoms subside) and they don't seem to cause the gut damage abx can cause.

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