Loose tooth and flare

[h202]

DS(7) had been on treatment dose augmentin for 6 months following his diagnosis. Then we tapered off abx, and he was successfully off for 7 weeks.  Then he had a minor-moderate flare at the beginning of November.  It took us 10 days to determine it really was a flare (symptoms got bad at day 10), then we started on abx again. Major symptoms immediately disappeared, and all symptoms fully remitted within 10 days of abx.  Doctor recommended staying on treatment dose abx longterm.  Son was on 500 augmentin twice a day, but two days ago we reduced to 375 (which is technically his treatment dose based on age, but his doctor had previously just rounded up).  So a 25% reduction in abx dosage starting two days ago.    

Not sure what caused the November flare: his strep antibodies are quite high, but he also lost a tooth in the peak of the flare (tooth fell out 3 days before worst symptoms/starting abx).  So could be either, or something else.  

Now in the last 24 hours, he seems like he has minor flare symptoms again (hyper and moody).  Two possibilities: He lost a tooth two days ago, but we also dropped the abx 2 days ago by 25%.  Not sure what the issue is, but when we tapered the abx in september, there was no increase in pandas symptoms.  So thinking this maybe tooth related.  This minor flare is not as bad as the november flare, but the major difference is he is already on antibiotics this time.  So presumably that would have helped take the edge off things.  

For those who have minor flares while on treatment dose abx, what's your protocol? Especially if tooth related?  Should we be increasing abx?  Should we just ride out a minor flare?  ibuprofen?  

[bobh]

Oh, a loose or lost tooth is a very common flare source. That would be my bet.