Penicillin or Azith

[melanie]

Hi spoke with the neuro today and were going to meet with a infectious disease md and decide which antibiotic to go with Penicillin or azith.Hes been on azith for approx 6 months had results but well we did the ivig I think danny may be allergic to Pennicillin I think one of my kids had a reaction I have to call the pediatrician.Any way lets say theres no allergy which ones better post IVIG?

 

Melanie

[dee45]

Hi Melanie,'

How is Danny doing?? Hope you are still seeing improvement. Have a good night well whats left of it.

 

Deanna

[EAMom]

I would vote for Azith. It has a longer half life so if you miss a dose, you are okay. Pen must be given 2x daily and if you miss a dose you are essentially unprotected for several days.

[P_Mom]

As far as dosing, yes, Azith would be sooo much more convenient than Pen Vk.....if you don't think you can stick to such a rigorous schedule...go with Azith. However, be aware that several strep strains have shown resistance to Azith...particularly in the Northeast...but, who knows if this resistance will "spread." The strep that started this PANDAS road with us falied to be eradicated by Azith (we live in PA) Penicillin also failed...it took Keflex to do the job. I think it varies so much. I spoke with Dr. Latimer today and again expressed my concern about Pen VK being sufficient. She expressed she fully believes it is. Once the strep is gone, Pen VK can keep it gone (although it does fail, they all do). She said that once PANDAS is in motion, the immune system is the problem, so, the antibiotic of choice for prophylaxis (given the strep is eradicated...you may need stronger ones to do that) is not the big issue and you should go with the safest, most narrow spectrum antibiotic that you can. However, if Pen ever fails for my kids (no failure for either in 1 1/2 years) I would not hesitate to switch....probably to Augmentin or Keflex because of the failure here in PA with Azith. However, I know Azith has helped many....and if Azith was what helped my kid...you bet I would be using it.

 

Kelly

[EAMom]

Interestingly, I just ran across this from a 2005 article by Swedo (Treatment of Sydenham’s Chorea With Intravenous

Immunoglobulin, Plasma Exchange, or Prednisone):

 

Prior studies have shown that both intramuscular penicillin

and oral antibiotics can fail to provide complete prophylaxis

against group A streptococcal infections, even when compliance

is optimal

 

And yes, I'm in California...so I'm definitely sticking with the Azith! We tried Augmentin, a 2nd gen. cephalosporin, and amoxcillin...azith is what worked for us.

[P_Mom]

Yes, that is what I mean. If you look hard enough, talk to enough people........... you will find that every antibiotic we talk about here on this forum has failed someone, somewhere. You just have to go with one and see what happens.

[Kayanne]

I completely agree with P.Mom and EAmom. I think there are many factors to consider. But the most important is weather you are sure his strep is completely cleared. You said he was on azith for six months...was that a prophylactic dose or full strength?

 

Strep can be in many different places: throat, sinuses, skin, gut, ear, vagina...

 

Theoretically speaking, sometimes the only way to be confident that strep is completely gone, is to see the slow recovery begin to happen (hopefully sooner in your case because of the IVIG). I think it is important to remember, as P.Mom pointed out, that this is autoimmune, and the nasty antibodies will not subside if there is an ongoing strep infection.

 

Azith is believed to have anti-imflammatory and immune-modulating properties, but Dr. Latimer told me that amox is thought to have those too. However, amox and pen cannot reach strep once it enters the cell.

 

In our experience, it was a high dose of clindamycin that cleared it for my PANDAS daughter...prior to that she took OMNICEF, AMOX, and AUGMENTIN combined with RIFAMPIN

 

Dr. Latimer did put my daughter on 100mg daily of Azith for prevention, but as I began to learn more, I became confident that I wanted to put my daughter on pen vk. I too was concerned about the azith resistant strep because I live in Eastern PA, but mostly I was concerned about azith being a broad spectrum antibiotic--when I took it for 10 days for my strep in the spring, I had some minor yeast issues...

 

We saw a rhumatologist who felt very confident that pen has a great track record of being a prophylactic.

 

Genetically speaking, I have an uncle who had RF as a child, and took pen for 20+ years...well into his adulthood without any side effects, and my daughter favors my side of the family.

 

The 2 times daily dosing is problematic....just last night I had to wake her up to give her the pen because we forgot it. Personally, I would rather deal with the dosing issue than be worrying about her being on a broad spectrum indefinately.

 

I was also worried that I would see a slip in her behavior if I switched from azith to pen vk, but Dr. Latimer assureed me that since we addressed her brain issues (steroids) we would not see any.

 

I'm glad to say that she has been on pen vk for a week, without any slip in behavior. Actually the two minor issues that she has had are now gone--I think her confidance took a hit and this last week being back in school...something clicked for her.

 

I'm sure you'll make the best decision for your situation.

 

Good luck

Karen