Update from our Dr. visit

[nojo]

I wrote earlier this week about our visit to pediatrician. We went yesterday, the whole family, with a huge notebook including many of the research papers cited here (thanks Buster) and sat with the pediatrician for over 45 minutes. Usually the office is packed, and for once, we walked in, it was totally empty, and he had time to really talk. He always tries to, and he does really try to help us, but the poor guy is swamped. Here is what we learned:

 

1. Last visit both kids tested positive on rapid test for strep, older daughter on prophylaxis augmentin, she has pandas. Younger daughter just completed amox round for positive strep earlier in month, missed some does because she broke her elbow, had to have surgery and pain meds made her throw up. I incorrectly assumed the culture was also positive since they did not call me to tell me. The culture was negative, so it would appear we had a false positive on the rapid test. I think this is good, because my understanding is, that they have strep in the lining of the throat, but it isn't an infection, it isn't able to grow. These are just dead or left over cells from the previous infection.

 

2. Older Daughter put on full strength Augmentin last visit per positive rapid. Just completed full round. Younger Daughter put on zithromax. During the course of Zithromax, younger daughter broke out in "strep" rash. I'm not sure if it is scarlet fever exactly, but it is a sand-papery rash on her back that is colorless. It spread to her stomach. For her, 90% of the time when she gets the rash, if I bring her in , she is strep positive. The doctor agreed yesterday, it does look like strep rash; however, it could be viral. We re-cultured both girls to make sure clear. No rapid tests taken yesterday, and from this point forward we always have to have a culture with a rapid.

 

3. After much debate over the merits of many antibiotics, both girls are put on prophylactic Augmentin provided they are clear. If they test positive on Augmentin, we are back to the drawing board on how to clear, and which prophylactic.

 

4. Because our school system is going out of its way to be unhelpful in a number of ways, we are going forward with homeschooling, primarily because I want to give both children a break from constantly being sick. We are going to take a few months to heal, get strong, sleep when we need to, and try to get our pandas daughter to actually put food into her body. Between the constant strep, and her severe asthma she needs a break.

 

So, this is where we are, I hope some of this is helpful. I know that our breakthrough on prophylaxis was scaring me, so I wanted to let everyone know what we had learned. If anyone has more information about the false positive on the rapid test I'd be interested. There was also some talk about the carrier state yesterday, which I know there is some talk on the boards about, and we aren't really understanding yet.

 

And for the record, I hate strep!

[Guest Angela Shaw]

2. Older Daughter put on full strength Augmentin last visit per positive rapid. Just completed full round.

 

Can you tell me her age, weight, and what the dosage is? we're still sorting this out with my dd. How long was the full round?

 

Angela

 

PS I hate strep too.

[nojo]

She's 7, 45 lb, 600mg 2x a day for 10 days. Prophylactic down to 1 time a day. The doctor said to make sure to do prophylatic dose in the morning to better protect her.

[ajcire]

Interesting. I know my office always does the culture if the rapid is negative but I didn't think they did the culture if the rapid came positive.

[Guest Angela Shaw]

She's 7, 45 lb, 600mg 2x a day for 10 days. Prophylactic down to 1 time a day. The doctor said to make sure to do prophylatic dose in the morning to better protect her.

Can you explain to me what prophylatic means? Is it just the particular dosage that the keep her on long term to prevent a reccurence strep infection? Is it the same drug? Are you just adding in more Augmentin for the ten days then go back to the long term dose?

 

Thanks.

Angela

[nojo]

She's 7, 45 lb, 600mg 2x a day for 10 days. Prophylactic down to 1 time a day. The doctor said to make sure to do prophylatic dose in the morning to better protect her.

Can you explain to me what prophylatic means? Is it just the particular dosage that the keep her on long term to prevent a reccurence strep infection? Is it the same drug? Are you just adding in more Augmentin for the ten days then go back to the long term dose?

 

Thanks.

Angela

 

The twice a day was a treatment dose when we thought she was positive. Prophylactic is to prevent getting strep. That is why were were bummed that it appeared she was positive via the rapid. It seemed the prophylactic dose wasn't working.

[EAMom]

Interesting. I know my office always does the culture if the rapid is negative but I didn't think they did the culture if the rapid came positive.

 

Yeah...you shouldn't have...unless you want to grow the strep for something fancy like strain analysis (do they even do that in private practice?).

 

Plus...if the rapid is positive, and the culture is neg...I would still believe the rapid. The culture could be neg. b/c it's a bad swab (dr. missed the tonsils).

[EAMom]

Yeah...I have a big question in my mind about using Augmentin once daily for prophylaxis, although a lot of docs seem to do this.

 

This is my problem. Swedo says pen MUST be given twice daily for prophylaxis due to it's short half-life. If you miss a dose you are essentially unprotected for several days. But, amoxicillin (which is part of Augmentin) doesn't have a half-life much longer than pen. (Clavulonic acid also has a short 1/2 life.) Pen's half-life is 1/2 hour. Amoxcillin's 1/2 life is 1 hour. So both drugs are essentially cleared from the system in 5-6 hours. So why are all these docs giving Augmentin ONCE daily to prevent strep???

 

In addition, I cannot find any studies that show that Augmentin given 1x daily is an effective strep prophylaxis.

[nojo]

Well that's a bummer. That would mean we are essentially unprotected still. What do you recommend? Our pediatrician would probably do zithromax, but he doesn't want to do that, and said we would do that only every 4th day b/c of half life. I think he is hoping less exposure to germs from school will be helpful. I just wish we could get some of this under control. At this point, I'm not confident we are clearing the strep, although the dr. thinks we are. For the record, we still aren't getting called back from Dr. Latimer, which is frustrating since we made the trip to see her last month.

[EAMom]

I'm really tired of these anti-biotic phobic pediatricians. Many on this forum have kids that are on 250mg/day Azith long term. Our dd (54 pounds, started at 42 pounds) has been on this dose daily since June 08. Our immunologist (Stanford) confirmed that this dose would be safe for her to stay on for YEARS.

[nojo]

I'm really tired of these anti-biotic phobic pediatricians. Many on this forum have kids that are on 250mg/day Azith long term. Our dd (54 pounds, started at 42 pounds) has been on this dose daily since June 08. Our immunologist (Stanford) confirmed that this dose would be safe for her to stay on for YEARS.

 

I guess I'll bring this info to our next visit. I can't bear to go again until we are sick again. Which at this rate, will be by Thanksgiving! Thanks for the info.