Augmentin as a strep prophylaxis

[EAMom]

Of those who have used Augmentin as a strep prophylaxis, have you given it once or twice daily? I seem to remember that some folks were doing the Augmentin once daily and was wondering if that is actually an optimal regime.

 

If I remember correctly Bmom's son got strep on once daily augmentin and Worrieddad's son got a sinus (strep?) infection on augmentin (I actually don't remember for sure if they were doing 1 or 2x daily so maybe they can chime in here.)

 

I know that pennicillin (tablets, not injectable) absolutely must be given twice daily (per swedo DAN! lecture). Swedo said that if you miss a dose you are essentially unprotected for several days. This is because of the short half-life of pen. vk (30 minutes).

 

As far as I can tell, Augmentin's half-life isn't much longer. The amoxcillin portion is 1.3 hours and the clavulonic acid(clav. acid makes the amoxcillin more effective) portion is 1.0 hour. (Compared to Azith. which has a 1/2 life of 68 hours.) This link http://books.google.com/books?id=DO-7q2Vzz...num=4#PPA202,M1 (see the top of page 202, chart) shows that with amoxicillin, there is pretty much no drug left in the blood stream after 8 hours. (So the same would hold true for Augmentin.)

 

In addition I haven't been able to find any literature that actually states that Augmentin (or amoxcillin) is an effective strep prophylaxis given 1x daily. Since it's half-life isn't much longer that Pennicillin's...it makes me think that it really needs to be given 2x daily to effectively prevent strep. Does anyone have more information on this?

[bmom]

Good question. Thanks. This is something I have been thinking about lately as well. My son is on 250 mg. of Augmentin one time daily. He is doing well, but did get strep on this. I emailed Dr. K and asked him because of that and his age (10) and weight (85 Lbs) if the dose should be higher. He said yes and ok'd 500 mg. The pharmacy just doubled the # of pills. I did read somewhere that one should not do 2 pills of 250 mg. because of the amount of potassium that is in them, but instead should be given a 500 mg pills (this was not referring to PANDAS, but in general). It said that the clavulanate potassium should remain the same and the augmentin dose should just be higher which is supposively what is in the 500 mg. dose. So any advice on this would be helpful. I am going to email Dr. K and ask him what to do as well. I have not started the higher dose as he is doing well and I just want to wait until summer. I do think I will start it though as I do not want him to get strep again. The half life makes sence though although makes it a little more difficult to time the probiotics- at least 2 hours after antibiotics.

[P_Mom]

Hi EAMom,

 

Your questions make me wonder...are you thinking of switching?

 

We do once daily Augmentin for both boys....58 lbs. and 88 lbs. So far, it has proven quite effective for us. I say that because my husband got strep (positive rapid, even on home test), and did not realize it for about 5 days. Actually what tipped us off was that my younger son got an increase in tics one day and my husband thought that maybe he should do a home swab because he had had a headache for several days...no sore throat. He came back positive. My sons symptoms lasted half a day, stopped once Dad got on antibiotic...did not at all get severe. So, it protected both boys from contracting strep from their own father with close exposure for several days. I had them cultured and titers ran afterward to be sure. My older son never even showed any increase of symptoms....which was amazing.

 

I know other people haven't had such luck...it just all depends

 

Kelly

 

p.s. we are having IVIG done for younger son by dr.K in July

[P_Mom]

BMom,

 

If I were you, I would take the pills back to the pharmacy and make them give you the 500 mg pills......the acid in two pills of 250 mg Augmentin pills to equal 500 mg Augmentin is too much and can be toxic to the liver....even for adults. There is caution about it all over the sites about Augmentin. The pharmacy should know better. (and should dr.K)

 

Kelly

[bmom]

PMOM,

How much are your sons 250 or 500 mg? Dr. K probably does know better. They had not ok'd it with Dr. K when I went in. They said they would get ahold of him, but until then I could just do 2 daily. I did not as I am waiting for school to be out. I will specifically ask for the 500 mg when I go in. Thanks!

[P_Mom]

250 mg once a day.....I'll stay with this as long as it continues to be effective....I like the idea of the least effective amount of antibiotic as possible....now if they get strep...that is a whole different story.

[P_Mom]

double post..edit.

[P_Mom]

BMom,

 

I wanted to say that if you are giving in a divided dose, twice a day, it is fine.

 

Kelly

[EAMom]

Hi bmom and pmom,

 

I thought it was really weird that my non-pandas younger dd (has gotten strep 2x this school year oct/dec; she is a carrier, no symptoms with these positive cultures; not on abs) did not get strep when I got it last month ( I was symptomatic for 6 days b-4 I realized I had strep and did the rapid). It was so weird since we were in pretty close quarters and together a lot (even more than normal...vacation) and she would occasionallly take food off my plate! We did 2 separate cultures a couple of weeks apart and nothing! My husband didn't get sick either. (My PANDAS dd had handwriting decline/other symptoms, apparently from colonization...she improved after I started my abs!)...So it could have been luck that prevented Pmom's kids from getting strep, not just the augmentin.

 

Anyway, I'm wondering if the once daily augmentin is somewhat effective but not optimal (not like giving it 2x daily) in preventing strep. I know when my dd was on amoxcillin prophylaxis she did 250mg twice daily.

 

I wasn't actually thinking of switching off the azith...but just wondering. Since we're hoping to do IVIG this summer I've been trying to figure out what makes IVIG seem sucessful for some but not so much for others and how much of an issue getting a strep infection post ivig is...