Sick on antibiotics?

[melanie]

Danny says his throat hurts how can he get strept on zithromax Im not sur if its strep yet Ill call the dr in the am but it sounds like it hes on 250mg daily zithro hes stuffy too maybe its allergys but just wanted to throw this out and see about feedback

[EAMom]

A sore throat on Azith. is most likely viral.

 

The other possibility is an Azith. resitant strain of strep. B.mom's ds did get strep while on antibiotics...so it is possible.

[colleenrn]

Melanie,

How much does Danny weigh? He has been on Zithromax 250mg for how long?

My daughter (12 yrs. old) has been on 250 mg/day of Zith since October and still got an ear infection. Should not be getting strep, but in the world of PANDAS, I would not rule anything out.

Colleen

[melanie]

Melanie,

How much does Danny weigh? He has been on Zithromax 250mg for how long?

My daughter (12 yrs. old) has been on 250 mg/day of Zith since October and still got an ear infection. Should not be getting strep, but in the world of PANDAS, I would not rule anything out.

Colleen

Dannyweighs about 125- 130 hes been onit for 1 month I am waiting for a refill for month 2 do you see alot of changes? HE didnt have strep it was neg at a medi center and hes not complainig thqat his throat hurts anymore so maybe it was allergys Dr starrted him on nystatin yesterday to make sure hes not making to much yeast are you doing thaT?

[EAMom]

Melanie...

my dd is 55# and on 250mg/day Azith. (she also was on this same dose last year when she was 10# less--45#)

If your son weighs 125-130 # IMO he should be on a higher dose of Azith, at least 500mg/day.

 

If he responds to Azith, perhaps you could eventually lower the dose back to 250mg (lower prophylactic dose), but for now, if you're trying to figure out if the Azith. is going to have an impact on his symptoms, I would do the higher dose.

 

When I google, the dose range for Azith. in children is 5-20mg/kg. If your son is 130# (59kg), 295 mg Azith/day would be the minimum (taking the low end of the dose range 5mg/kg) he should be getting. 500mg/day (8.5 mg/kg) would be a more appropriate dose for him.

 

Also, be aware that Azith. helps PANDAS b/c it prevents strep (and gets intracellular strep) but it is also anti-inflammatory and immune-modulating...so even though I could techinically give my dd a lower dose (125mg/day) and it would still probably work to prevent strep, I would also effectively be lowering the anti-inflammatory and immune-modulating dose in half...not a good thing!

 

Of course, we don't know if your child has PANDAS...but a trial of Azith. at such a low dose (IMO!) is not a very good test.

[melanie]

Melanie...

my dd is 55# and on 250mg/day Azith. (she also was on this same dose last year when she was 10# less--45#)

If your son weighs 125-130 # IMO he should be on a higher dose of Azith, at least 500mg/day.

 

If he responds to Azith, perhaps you could eventually lower the dose back to 250mg (lower prophylactic dose), but for now, if you're trying to figure out if the Azith. is going to have an impact on his symptoms, I would do the higher dose.

 

When I google, the dose range for Azith. in children is 5-20mg/kg. If your son is 130# (59kg), 295 mg Azith/day would be the minimum (taking the low end of the dose range 5mg/kg) he should be getting. 500mg/day (8.5 mg/kg) would be a more appropriate dose for him.

 

Also, be aware that Azith. helps PANDAS b/c it prevents strep (and gets intracellular strep) but it is also anti-inflammatory and immune-modulating...so even though I could techinically give my dd a lower dose (125mg/day) and it would still probably work to prevent strep, I would also effectively be lowering the anti-inflammatory and immune-modulating dose in half...not a good thing!

 

Of course, we don't know if your child has PANDAS...but a trial of Azith. at such a low dose (IMO!) is not a very good test.

 

 

 

 

Should I mention that to his dr? Shouldnt he know that Also how do you get the insurance company to pay for the zithro? One more thing is there a zithro that isnt pink Im thinking that they may use red dye He has had several tests for strep cant prove he has Pandas but Dr believes he does so were treating him for it since hes been on it things have gotten alot better hes alot clearer hes still ticcing (cursing)(breathing) butnot as bad cant you tell by my posts hes talking alot hes not as angry less rages Life has been much better still want more lots more Ill speak to the dr monday and should I say that its soposed to be 500 mg ? Let me know thanks from me and danny

[EAMom]

Hi Melanie,

 

yes, I would ask for the 500mg/day dose. Maybe your doc is intentionally giving your son a lower prophylactic dose (not a therapeutic dose) thinking he only needs to prevent a new strep infection???....but IMO, that lower dose is something to consider after your son is improved (assuming it's PANDAS) to prevent future strep infections, not while you are in the midst of an exacerbation/behavioral symptoms/tics. It's possible your son has strep hiding out (even if throat culture is neg) somewhere in his body (sinuses, skin), and that is why you need the therapeutic dose.

 

How old is your son?

 

Yes, Azith. comes in a white pill (dye free I assume) in addtion to the reddish one.

 

Last year our HMO would only pay for 5 days/mo. of Azith. We eventually got around that problem with something called a non-formulary authorization form (which your doc can fill out for you)...although this maybe a problem if your DAN! is not working with insurance??? We don't have that restriction with our current PPO. If you can't get insurance to pay, there are some places that have better prices on Azith. that others. I remember Cost-Co being pretty reasonably priced.

 

That is good news that he is improving on Azith. Tics were the symptoms that took the longest to go away in our dd (they're back now, but not bad...were gone from July-Sept.). Ask your doc if it would be safe (okay) to add in Ibuprofen (Motrin, Advil), we think that helped mood/sleeping. I know he is on other drugs so you should check if it is okay first. I don't know if the Ibuprofen helped the tics though.

[melanie]

Hi Melanie,

 

yes, I would ask for the 500mg/day dose. Maybe your doc is intentionally giving your son a lower prophylactic dose (not a therapeutic dose) thinking he only needs to prevent a new strep infection???....but IMO, that lower dose is something to consider after your son is improved (assuming it's PANDAS) to prevent future strep infections, not while you are in the midst of an exacerbation/behavioral symptoms/tics. It's possible your son has strep hiding out (even if throat culture is neg) somewhere in his body (sinuses, skin), and that is why you need the therapeutic dose.

 

How old is your son?

 

Yes, Azith. comes in a white pill (dye free I assume) in addtion to the reddish one.

 

Last year our HMO would only pay for 5 days/mo. of Azith. We eventually got around that problem with something called a non-formulary authorization form (which your doc can fill out for you)...although this maybe a problem if your DAN! is not working with insurance??? We don't have that restriction with our current PPO. If you can't get insurance to pay, there are some places that have better prices on Azith. that others. I remember Cost-Co being pretty reasonably priced.

 

That is good news that he is improving on Azith. Tics were the symptoms that took the longest to go away in our dd (they're back now, but not bad...were gone from July-Sept.). Ask your doc if it would be safe (okay) to add in Ibuprofen (Motrin, Advil), we think that helped mood/sleeping. I know he is on other drugs so you should check if it is okay first. I don't know if the Ibuprofen helped the tics though.

 

 

I will talk to the DR monday about getting athe authorization.Hes under my insurance I called the Pharm and rite aid said it was 250.00 for the script. I pay 5-15$ copays for scripts so I thought that was alot But Ill pay if it works ..Danny will be 15 next month getting older hes on 30mg buspar and 3 mg tenex also Inositom ,mag taurate,lecitin,b6,taurine. I was giving him advil 200-400mg for the sore throat seemed ok on it. I did give him some benadryl thursday because I thought the sore throat was allergy rlated .The sore throat is gone He was a little aggitated todayb but not so bad Oh yea hes taking nystatin 3rd day today to make sure hes not building to much yeast from the zithromax.

[peglem]

But, even for full grown adults- therapeutic dose (the z-pac) is 500mg the 1st day and 250mg/day after that. Zith builds up in your tissues and can be bad for your liver. I'd be very careful about giving too much.

[melanie]

But, even for full grown adults- therapeutic dose (the z-pac) is 500mg the 1st day and 250mg/day after that. Zith builds up in your tissues and can be bad for your liver. I'd be very careful about giving too much.

 

So the answer is 250?500?

[EAMom]

My 2 cents..if you want to see if Azith. is really making a difference I would try the 500mg before making a decision (esp. if you're not sure and he's already been on the 250mg dose). That is just my opinon, but the decision is between you and your doctor. Most of the kids that are on 250mg are much smaller than your son (who is basically adult size).

 

Perhaps if you have liver concerns you could have your doc run a liver panel done and also ask your DAN! about adding on SAMe etc. to help protect the liver. Also, make sure your son stays away from other things which are known to be bad for the liver (tylenol, alcohol).

 

No drug is going to be 100% safe. (On the same level, IVIG is not guaranteed to be 100% safe.) In the grand scheme of things, a 2 mo. trial of Azith. is going to be much safer than most of the psych. drugs that are out there (SSRI's with black box warnings, risperdal, etc.).

 

Also, re. Azith. dosing...the the dose for treating strep is going to be higher than doses for other things...the ped explained this to me the other day when I took my non-PANDAS younger dd in for a strep test but she also had a possible ear infection. She said if the culture came back positive, the Azith. dose she would need would be higher than if we were using it to treat the ear infection. Also, it is my opinion that some of these PANDAS kids don't have a "normal" immune system, so you can't necessarily apply regular treatment guidelines to them.

 

That said, most of the PANDAS kids on this forum are much younger...I have no idea how the Azith. would work on your son (assuming he even is PANDAS) if he is already almost 15 (post-puberty I assume). Anyway, that is my opnion Melanie, you are the one who needs to decide (as with other drugs he is on) if the risk outweighs the possible benefit in your son.

[colleenrn]

Melanie,

Given your son's age and weight, I agree with EAMom's suggestion of increasing the Zithromax to 500mg/day, even if it is just for a 10 day course. You could then re- evaluate switching to a dose of 250mg. My niece who is 8 and weighs about 65 lb. was put on a ten day course of 500mg/day of Zithromax by her pediatrician. This pediatrician is very cautious with antibiotics, but told my sister that in the case of strep throat, and given that my niece was in a bad episode of PANDAS, the 10 day course of 500mg was warranted.

 

My daughter weighs about 125 and is 12 1/2. She is taking Zith 250mg/day, but when I see a big flare up of PANDAS symptoms, I bump her up to 500mg, usually for 5 days.

Talk to your doctor about it. Certainly a short course of Zith 500mg is not going overboard at all, IMO.

Colleen