What are the chances this is strep?

[monarchcat]

We are on day 11 of Azith 250mg/day (this is our first course of treatment for PANDAS). He was restless all night then woke at 4:30am with a headache, low fever, sore throat and nausea (he gets nauseous whenever he gets a fever so it may or may not be part of whatever he has). He took an advil and after an hour or so claimed that he "feels fine". Maybe a tiny headache, but no sore throat and his belly feels better (ate pancakes for breakfast and was mad I wouldn't make him bacon).

 

I'm so afraid of strep and of course since he's back in school now... it certainly is possible.

 

He's been doing GREAT the past few days... a dream child. Has said the tics are better and he is "less anxious" at school. This morning he's been definitely grumpier... within the normal range for any 8 year old boy who doesn't feel all that great, but different than the last few days when we've seen remarkable glimpses of a happy, patient, sweet, kind boy. I totally expect, though, that whatever he has will trigger some PANDAS symptoms, even on the azith.

 

How likely is it that he would have strep on that dose of azith (he's about 80lbs)? If it is strep, would he culture positive or would the antibiotics interfere somehow? I Have an appt for a culture at 1:15 today, but wanted to see what your experiences were. My ped practice doesn't know a lot about PANDAS.

 

Thanks!

[Kayanne]

Are you on the azith because he tested positive for strep 11 days ago? Or is this for a prophylactic? Or are you trying to see if azith's other properties (immune-modulating and anti-inflammmatory) will help bring your son out of his PANDAS exercerbation?

 

250 mg is the standard full strenth dose for treating infection (the 5 day zith packs are day 1: 500mg and days 2-5: 250mg)

 

However, I think colleenrn recently posted that she has heard from a doctor that 500mg is required for infection.

 

Can you ask around to see if he may have been exposed to strep from somewhere? Having an idea if he was exposed or not will probably be your best clue as to if this is strep or not. Is anyone else in the house complaining of a sore throat? If so, a rapid strep and/or culture on that person could help you to determine if this is strep or not.

 

I'm saying to maybe look at the whole picture because I don't think you will get a positive culture being on the antibiotic; however you may get a positive result on the rapid strep test....I was told that by my daughter's ped practice that if there are any strep antigens present, the rapid could pick it up better...you see the rapid antigen test and a culture are two different processes.--but always remember those tests are only as accurate as the sample taken, so make sure the nurse/doctor is thorough....not helpful for our kids though. Personally, I think since you are on what is considered to be a full dose, then the chances of getting anything positive is not likely.

 

This summer my daughter was only on 100mg of azith (she was 45 lbs) daily as a prophylactic, and I had to take her in a couple of times for a red/sore throat--rapids and cultures were both negative...but I believed the results of the rapid because others in the house had a normal cold with sore throat.

[monarchcat]

He didn't have strep 11 days ago, he was started on the azith after receiving the Cunningham study results. I don't know if there is any strep around, but, of course, in a third-grade classroom that's always possible. And, yes, it seems like azith was doing it's job of either eradicating any "hidden" strep and/or the other properties were helping (along with advil). His symptoms were way down.

 

I'm wondering if there are any strains around that are resistant to azith... the advil is wearing off and he has a sore throat, fever, headache.... definitely "quacks" like strep. LOL

 

 

Are you on the azith because he tested positive for strep 11 days ago? Or is this for a prophylactic? Or are you trying to see if azith's other properties (immune-modulating and anti-inflammmatory) will help bring your son out of his PANDAS exercerbation?

 

250 mg is the standard full strenth dose for treating infection (the 5 day zith packs are day 1: 500mg and days 2-5: 250mg)

 

However, I think colleenrn recently posted that she has heard from a doctor that 500mg is required for infection.

 

Can you ask around to see if he may have been exposed to strep from somewhere? Having an idea if he was exposed or not will probably be your best clue as to if this is strep or not. Is anyone else in the house complaining of a sore throat? If so, a rapid strep and/or culture on that person could help you to determine if this is strep or not.

 

I'm saying to maybe look at the whole picture because I don't think you will get a positive culture being on the antibiotic; however you may get a positive result on the rapid strep test....I was told that by my daughter's ped practice that if there are any strep antigens present, the rapid could pick it up better...you see the rapid antigen test and a culture are two different processes.--but always remember those tests are only as accurate as the sample taken, so make sure the nurse/doctor is thorough....not helpful for our kids though. Personally, I think since you are on what is considered to be a full dose, then the chances of getting anything positive is not likely.

 

This summer my daughter was only on 100mg of azith (she was 45 lbs) daily as a prophylactic, and I had to take her in a couple of times for a red/sore throat--rapids and cultures were both negative...but I believed the results of the rapid because others in the house had a normal cold with sore throat.

[Kayanne]

I'm wondering if there are any strains around that are resistant to azith... the advil is wearing off and he has a sore throat, fever, headache.... definitely "quacks" like strep. LOL

 

Yes, there is a strain resistant to azith in Western PA....I think P.Mom didn't have good results with azith because of it.

 

Good Luck

~Karen

[dcmom]

Hi- sorry this is tough.

 

It seems most likely he won't culture positive while on abx. There are some strains of strep that are resistant to zithromax, I believe- but I would think that would be rare. Maybe there is a possibility to do a combo of antibiotics just in case? possibly you could try Clindamyacin? Could your ped consult with an infectious disease doctor?

 

I would also check with the school nurse, principal and teacher to see if strep is going around. It could be viral, which may cause an uptick in symptoms anyway.

 

Good luck and keep us posted.

[monarchcat]

Back from the appt. Rapid test was negative and the NP said the 24 hour could be neg too because he's on abx, but that he looks streppy. She said that the 250mg/day of azith that he is on is not enough to wipe out an active strep infection so she put him on 500mg for the next five days, then back to 250mg. Even if it's viral, I think I'm happy to have him on the short course of higher strength in case of hidden strep.

 

It's funny, he's been so amazing the last couple days and today I definitely see the snappy irritability/irrationality back, but then he'll have moments when he's super sweet. A definite mix. I'm keeping him on advil, too so maybe that will help the PANDAS symptoms somewhat.