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Amoxicillin made tics worse and started vocal tic


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My 11 year old son has had chronic tics for 2 1/2 years along with occasional vocal tic (sniffing). He currently takes 75 mg. of Zoloft and 1/2 of Clonadine in PM and 3/4 of Clonadine, 3 Fish Oil, Mag./Calcium, Vit. E in AM. PANDAS has been suspected for some time. A little over 2 1/2 years ago his hands and feet peeled, he had slightly elevated titer levels and two weeks later he had rapid onset of neck jerking tic. Over the past 2 1/2 years he has had periods of being tic free (about 2 months) only for the tics to return and new ones added. The past year the tics haven't gone away but at times his hands will peel at which time the tics will get much worse.

 

Three weeks ago he got sick (sore throat, fever). He was on a five day course of antiobiotic (Zithromax). One week after that his hands peels and tics greatly worsened. I took him to his pediatrician, he had no signs of being sick. I took him because his tics were worse, his hands were peeling and we are trying to get to the bottom of whether it's PANDAS related. His pediatrician took a throat culture and it tested positive. Titer level hasn't come back.

 

Because we have been dealing with this so long and different things have been tried we decided to try 10 days of Amoxicillin followed by at least 30 days of twice daily Pennicillin.

 

Within hours after receiving the second dose of Amoxicillin the tics were at the worse in 2 1/2 years and the vocal tic that he hadn't had in months returned. The vocal tic used to be only in the morning but now is constant and happens every 5 to 10 seconds. I waited 4 days and discontinued the Amoxicillin. I will speak with his pediatrician tomorrow when the office opens. My question is has anyone else experienced this? I've read that quite a few people had had good luck with Keflex and Azithromiacin. Please give me your thoughts.

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This happened with my son....about 4 days into the Keflex for strep, his vocal tics and behaviors that he had increased dramatically. This was not contributed to the Keflex, it was just the antibodies spiking at that time from strep....we continued with the Keflex and everything waned slowly over time to just about 0 symptoms. I am not saying that Amox. is not your problem, just that I think many times when a PANDAS child waxes or wanes due to their immune disorder, whatever the child is taking at the time it happens is given the credit for the worsening and improvement.

 

Your child has possibbly had PANDAS for a few years, and now had a positive strep test....this is what happens....the tics, ocd, etc., spike dramatically......and many times this happens regardless of antibiotics, especially if your child has haad PANDAS for some time.

 

When you say your childs hands are peeling, do you mean excema? My sons excema, which includes some peeling, always gets worse with PANDAS flairs.

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Hi KimDeL, wow, there's a lot in here... I wasn't sure what med was for what symptom from the post.

 

You mentioned Zoloft and Clonadine but was this for treating the tics or was there some other condition being treated?

 

Has your doctor ruled out Kawasakis Disease?

http://www.aocd.org/skin/dermatologic_dise...is-disease.html

 

I agree with P.Mom here that what you might be seeing is just the response to strep and it doesn't have anything to do with the medication. Of course there could be a cross reaction.

 

 

I can say that in our case (i.e., with our dd) our symptoms are pretty time driven. We see the following:

  • dd is on propholaxis antibiotic
  • we observe a ramp in separation anxiety and some defiance
  • we culture sister and sister comes back positive for GABHS
  • we treat sister
  • at 5-7 days after starting treatment, dd has a vocal tic and movement/measurement rituals
  • two weeks later movement/measurement rituals disappear
  • we culture sister and sister comes back negative for GABHS (i.e., we check that we cleared sister)
  • one to two weeks later vocal tic disappears

so full cycle is 3-4 weeks until we're back to baseline.

 

So checking on your chronology:

  • He had a sore throat and azithromycin was prescribed.
  • You had increased peeling/tics a week later
  • At three weeks from starting azith (2 weeks from completing) you took him to the doctor and
  • a throat culture came back positive for strep -- i.e., strain was not stopped with azith

Right?

 

Has he ever been on steroids over the past 2 years?

 

Three weeks ago he got sick (sore throat, fever). He was on a five day course of antiobiotic (Zithromax). One week after that his hands peels and tics greatly worsened. I took him to his pediatrician, he had no signs of being sick. I took him because his tics were worse, his hands were peeling and we are trying to get to the bottom of whether it's PANDAS related. His pediatrician took a throat culture and it tested positive. Titer level hasn't come back.

 

Regards,

 

Buster

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My son always gets amox when he gets strep. The symptoms continue to worsen for 3-4 days after the start of antibiotics then the slow recovery process finally begins.

 

If you think about it. A child is still contagious until being on amox for 24 hours, therefore, the antibodies are still being produced and causing more and more inflamation during that time. Then you have to wait for the antibodies to stop producing and finally for the swelling to decrease before you see any improvement or at least reach a plateau.

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This happened with my son....about 4 days into the Keflex for strep, his vocal tics and behaviors that he had increased dramatically. This was not contributed to the Keflex, it was just the antibodies spiking at that time from strep....we continued with the Keflex and everything waned slowly over time to just about 0 symptoms. I am not saying that Amox. is not your problem, just that I think many times when a PANDAS child waxes or wanes due to their immune disorder, whatever the child is taking at the time it happens is given the credit for the worsening and improvement.

 

Your child has possibbly had PANDAS for a few years, and now had a positive strep test....this is what happens....the tics, ocd, etc., spike dramatically......and many times this happens regardless of antibiotics, especially if your child has haad PANDAS for some time.

 

When you say your childs hands are peeling, do you mean excema? My sons excema, which includes some peeling, always gets worse with PANDAS flairs.

 

Hi P.Mom - Thanks for your info. No it's not excema, it's only the bottoms of his hands and his pediatrician and pediatric neurologist seem to believe there's a correlation between the peeling and tics.

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Hi KimDeL, wow, there's a lot in here... I wasn't sure what med was for what symptom from the post.

 

You mentioned Zoloft and Clonadine but was this for treating the tics or was there some other condition being treated?

 

Has your doctor ruled out Kawasakis Disease?

http://www.aocd.org/skin/dermatologic_dise...is-disease.html

 

I agree with P.Mom here that what you might be seeing is just the response to strep and it doesn't have anything to do with the medication. Of course there could be a cross reaction.

 

 

I can say that in our case (i.e., with our dd) our symptoms are pretty time driven. We see the following:

  • dd is on propholaxis antibiotic
  • we observe a ramp in separation anxiety and some defiance
  • we culture sister and sister comes back positive for GABHS
  • we treat sister
  • at 5-7 days after starting treatment, dd has a vocal tic and movement/measurement rituals
  • two weeks later movement/measurement rituals disappear
  • we culture sister and sister comes back negative for GABHS (i.e., we check that we cleared sister)
  • one to two weeks later vocal tic disappears

so full cycle is 3-4 weeks until we're back to baseline.

 

So checking on your chronology:

  • He had a sore throat and azithromycin was prescribed.
  • You had increased peeling/tics a week later
  • At three weeks from starting azith (2 weeks from completing) you took him to the doctor and
  • a throat culture came back positive for strep -- i.e., strain was not stopped with azith

Right?

 

Has he ever been on steroids over the past 2 years?

 

Three weeks ago he got sick (sore throat, fever). He was on a five day course of antiobiotic (Zithromax). One week after that his hands peels and tics greatly worsened. I took him to his pediatrician, he had no signs of being sick. I took him because his tics were worse, his hands were peeling and we are trying to get to the bottom of whether it's PANDAS related. His pediatrician took a throat culture and it tested positive. Titer level hasn't come back.

 

Regards,

 

Buster

 

Thanks for your reply Buster. Kawasaski's disease has been ruled out. Your chronology is correct. The azithromycin did not cause any increase in tics when my son was taking it but shortly after taking the Amoxicillin it was like nothing we had ever seen.

 

He has not taken steroids in the past two years - why do you ask, I'm curious? Thanks again. KimDeL

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Hi KimDeL, wow, there's a lot in here... I wasn't sure what med was for what symptom from the post.

 

You mentioned Zoloft and Clonadine but was this for treating the tics or was there some other condition being treated?

 

Has your doctor ruled out Kawasakis Disease?

http://www.aocd.org/skin/dermatologic_dise...is-disease.html

 

I agree with P.Mom here that what you might be seeing is just the response to strep and it doesn't have anything to do with the medication. Of course there could be a cross reaction.

 

 

I can say that in our case (i.e., with our dd) our symptoms are pretty time driven. We see the following:

  • dd is on propholaxis antibiotic
  • we observe a ramp in separation anxiety and some defiance
  • we culture sister and sister comes back positive for GABHS
  • we treat sister
  • at 5-7 days after starting treatment, dd has a vocal tic and movement/measurement rituals
  • two weeks later movement/measurement rituals disappear
  • we culture sister and sister comes back negative for GABHS (i.e., we check that we cleared sister)
  • one to two weeks later vocal tic disappears

so full cycle is 3-4 weeks until we're back to baseline.

 

So checking on your chronology:

  • He had a sore throat and azithromycin was prescribed.
  • You had increased peeling/tics a week later
  • At three weeks from starting azith (2 weeks from completing) you took him to the doctor and
  • a throat culture came back positive for strep -- i.e., strain was not stopped with azith

Right?

 

Has he ever been on steroids over the past 2 years?

 

Three weeks ago he got sick (sore throat, fever). He was on a five day course of antiobiotic (Zithromax). One week after that his hands peels and tics greatly worsened. I took him to his pediatrician, he had no signs of being sick. I took him because his tics were worse, his hands were peeling and we are trying to get to the bottom of whether it's PANDAS related. His pediatrician took a throat culture and it tested positive. Titer level hasn't come back.

 

Regards,

 

Buster

 

Buster - Sorry I forgot to say that the Zoloft and Clonadine are being prescribed by my son's pediatric neurologist to see if it could help with tics, some OCD symptoms. So far no luck. I am seriously hoping an antibiotic of some sort will help my son.

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KimDel-

I just posted a comment on this thread about the peeling hands, but then went back and read your initial post.

 

Your son was on 5 days of Zith, a week later peeling on hands with a positive strep, then was put on Amoxicillin. It very well may be that the Amoxicillin is not getting to the strep and he still has strep. This would definitely explain the peeling on his hands which could be from strep. The 5 days of Zithromax was probably not long enoughh to erradicate the strep. Would your doctor be willing to switch to Zithromax today?

Colleen

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Kawasaski's disease has been ruled out. Your chronology is correct. The azithromycin did not cause any increase in tics when my son was taking it but shortly after taking the Amoxicillin it was like nothing we had ever seen.

 

He has not taken steroids in the past two years - why do you ask, I'm curious? Thanks again. KimDeL

 

Hi KimDeL, I was asking about the Clonidine because it generally is given to lower blood pressure by binding to noepinephrine. It was a bit surprising to see in the list of meds. It is used for Tourettes and ADHD, but I was wondering why your doctor prescribed it.

 

On the steroids, I was asking because of the Clonidine. There is one treatment I had seen where steroids were used to lower B-cell activation and Clonidine was used to minimize blood-brain-barrier disruption due to high-blood presure.

 

Something maybe to consider here is that azith does a lot more than just be an antibiotic. It is immunomodulating (shifting Th2 response to Th1 response) and anti-inflammatory. Amoxicillin does not have these two properties. Hard to say what was going on. Glad to hear about Kawasaki's being ruled out.

 

Buster

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KimDel-

I just posted a comment on this thread about the peeling hands, but then went back and read your initial post.

 

Your son was on 5 days of Zith, a week later peeling on hands with a positive strep, then was put on Amoxicillin. It very well may be that the Amoxicillin is not getting to the strep and he still has strep. This would definitely explain the peeling on his hands which could be from strep. The 5 days of Zithromax was probably not long enoughh to erradicate the strep. Would your doctor be willing to switch to Zithromax today?

Colleen

 

I had the same thought, Colleen. Five days isn't long enough to treat systemic strep, at least not for my son. The year he was diagnosed, he had hand peeling after several rounds of ineffective antibiotics (mostly amoxy). We used cultured swab and ASO to confirm strep had not been eradicated. We saw the hand peeling only once more, a year later, after the pediatrician used too low an antibiotic dose for a suspected (then confirmed) strep infection. It happened because his pediatrician started thinking of his condition as strep throat, which it is not. His symptoms only exacerbate if given the wrong medication(s) or too low a dose for too short a time. The dilemma is that doctors are trained to think of parents as begging for unnecessary antibiotics as a quick fix. Some parents do that. For SC/pandas, we have found better, stronger, longer antibiotics are definately dictated--and healthy nutrition, supplements and proph prevention in between.

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KimDel-

I just posted a comment on this thread about the peeling hands, but then went back and read your initial post.

 

Your son was on 5 days of Zith, a week later peeling on hands with a positive strep, then was put on Amoxicillin. It very well may be that the Amoxicillin is not getting to the strep and he still has strep. This would definitely explain the peeling on his hands which could be from strep. The 5 days of Zithromax was probably not long enoughh to erradicate the strep. Would your doctor be willing to switch to Zithromax today?

Colleen

Hi Colleen - I took my son to his pediatrician on the 18th and he is now on Keflex for 10 days to be followed by Penicillin. I let you know how that goes. Thanks for your reply. Kim

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