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Prophylactic antibiotics


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Hi.

 

My son has had pretty high anti-DNASE levels (680 last winter, high 300's early fall). He has had a lot of tics in the past, but not very many recently. Not sure if it is due to DNASE levels going down, and/or to supplementation, allergen avoidance, and really cutting out most artificial colors and flavors. I actually think it is mostly peanut-avoidance, because we see a spike whenever he inadvertently eats peanuts (to which he is mildly allergic).

 

However, he is probably going to need a tooth extraction soon. He has a tooth coming in and the old one probaby isn't wiggly enough to come out by itself. He needed an extraction last winter for the same reason, and it was right before a major tic spike, so I want to explore prophylactic antibiotics, due to the high anti-DNASE levels.

 

Any advice on which antibiotics/dosage/how long? I have a call into his pediatrician, but I don't know if she has a lot of experience in this arena.

 

Thanks!

 

-- Liane

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Hi.

 

My son has had pretty high anti-DNASE levels (680 last winter, high 300's early fall). He has had a lot of tics in the past, but not very many recently. Not sure if it is due to DNASE levels going down, and/or to supplementation, allergen avoidance, and really cutting out most artificial colors and flavors. I actually think it is mostly peanut-avoidance, because we see a spike whenever he inadvertently eats peanuts (to which he is mildly allergic).

 

However, he is probably going to need a tooth extraction soon. He has a tooth coming in and the old one probaby isn't wiggly enough to come out by itself. He needed an extraction last winter for the same reason, and it was right before a major tic spike, so I want to explore prophylactic antibiotics, due to the high anti-DNASE levels.

 

Any advice on which antibiotics/dosage/how long? I have a call into his pediatrician, but I don't know if she has a lot of experience in this arena.

 

Thanks!

 

-- Liane

 

I've heard from various people on this site that any antibiotic they try works great at first, then doesn't seem to work as well after awhile. So you might as well start with the lower end and work your way up. My daughter is on augmentin 250 per day and will probably stay on this. Some people swear by zithromycin (I think they were using 500mg once a week). If you can do natural garlic (one clove a day) its a powerful antibacterial (plus anti-viral & anti-fungal). You could do that for a while, then back off on abx and see what happens. That's what I plan to do after about 3 months on the abx. (well, at least that's what I'm thinking now that I'll do - don't know what I'll think in 3 months from now). Pat

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A rhuematologist should know.

 

Our 8 year old is on 250mg Azithromycin/day (didn't respond to Augmentin, Amoxicillin, Cephalopsproin) long term. The last time she got her teeth cleaned I (being a spaz) added on 250mg Amoxicillin the morning and afternoon of the cleaning. She was fine.

 

Have you thought about getting a throat culture before the dentist visit?...just to check for a strep carrier state? (I would still do the abs even if the culture was neg though!)

 

Otherwise I'm guessing 10 days of abs would be fine you're not already on them long term. Start the morning before the extraction. After 10 days, any wounds in the mouth should be healed up. I believe that is the concern, strep from the throat being released into the bloodstream with an extraction (or cleaning).

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A rhuematologist should know.

 

Our 8 year old is on 250mg Azithromycin/day (didn't respond to Augmentin, Amoxicillin, Cephalopsproin) long term. The last time she got her teeth cleaned I (being a spaz) added on 250mg Amoxicillin the morning and afternoon of the cleaning. She was fine.

 

Have you thought about getting a throat culture before the dentist visit?...just to check for a strep carrier state? (I would still do the abs even if the culture was neg though!)

 

Otherwise I'm guessing 10 days of abs would be fine you're not already on them long term. Start the morning before the extraction. After 10 days, any wounds in the mouth should be healed up. I believe that is the concern, strep from the throat being released into the bloodstream with an extraction (or cleaning).

 

 

I was curious - when you said that your son did not respond to augmentin or the other abx you mentioned - what exactly did you mean - no improvement in behavior at all or some for a while? When you started the zith did that make an immediate difference and how long has he been on it now?

 

We started augmentin a couple of days after IVIG the first week in October - It's been a month and a half now, and I can't tell if its working or not because her symptoms are pretty much the same as they were before the IVIG (although there was a 2week period right afterwards with tremendous improvement) so I'm not really sure if her behavior now means that the IVIG didn't work very well, or if the antibiotics aren't working or if it's neither of those and I just need to be patient and wait for about a year to see resolution (which parents before me have said). Pat

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Pat...our dd had intial mood improvement on Augmentin (rx for 10 days) in March (within 24 hours), but still *lots* of OCD/tics/eating disorder/weird behavior. She had other things going on at the time (Klonopin, hosp. re-feeding) but we do feel the Augmentin helped (probably by knocking down the shear numbers of strep.) She got worse again on Amoxicillin (may have gotten re-infected from strep carrier sister but it's likely the strep never totally went away). A Cephalosporin in May (stronger version of Keflex) didn't help either (she was getting much worse at that point). In June we started Azithromycin. Mood was better in 3-5 days. OCD/anorexia nervosa was better in 10days (after 5 mo. of eating disorder).

 

Her strep carrier 5-year-old sister wasn't cleared on Augmentin (initially culture neg after Augmentin, positive again 2 weeks later). She was cleared on Azithromycin (neg 3 weeks later).

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  • 3 weeks later...
Hi.

 

My son has had pretty high anti-DNASE levels (680 last winter, high 300's early fall). He has had a lot of tics in the past, but not very many recently. Not sure if it is due to DNASE levels going down, and/or to supplementation, allergen avoidance, and really cutting out most artificial colors and flavors. I actually think it is mostly peanut-avoidance, because we see a spike whenever he inadvertently eats peanuts (to which he is mildly allergic).

 

However, he is probably going to need a tooth extraction soon. He has a tooth coming in and the old one probaby isn't wiggly enough to come out by itself. He needed an extraction last winter for the same reason, and it was right before a major tic spike, so I want to explore prophylactic antibiotics, due to the high anti-DNASE levels.

 

Any advice on which antibiotics/dosage/how long? I have a call into his pediatrician, but I don't know if she has a lot of experience in this arena.

 

Thanks!

 

-- Liane

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My 11 yo has a pretty mild case of P.A.N.D.A.S. (thank goodness) but recently I noticed some escalation of OCD behaviors and less impulse control. We put him on a prophylactic dose of amoxicillin which seems to do well for him. The dosage depends on your child's age and weight, of course. We start him on the initial dose of 750mg, then give him 250mg everyday. During cold and flu season we take no chances. We have the school report any Strep illnesses immediately so we can be pro-active. He'll be on antiobiotics for the next 60 days then we'll re-evaluate. I don't know if it's wishful thinking but I truly notice a difference in his behavior after a course of antibiotics. We recently had to change Neuro-Psychiatrists due to new insurance and luckily this doctor understands the condition and is as pro-active as we are so I would recommend finding a good Neuro-Psych in addition to an understanding Pediatrician. Bring in on the literature you can find to your Peds doc and don't take no for an answer.

 

Good luck.

Lori

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